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Suliemeh Y, Bouabane M, Deershamarkha M, Benzirar A, El Mahi O. Type III Endoleak Leading to Aortic Rupture After Endovascular Repair. Cureus 2022; 14:e26895. [PMID: 35978736 PMCID: PMC9375828 DOI: 10.7759/cureus.26895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 12/04/2022] Open
Abstract
Endovascular treatment of abdominal aortic aneurysm concerns the introduction of aortic endoprosthesis which aims to isolate aneurysm from the circulation. The leading complication of this technique is the endoleak which is defined by the persistence of blood flow within the aneurysm sac. The main risk is the rupture of the aorta which can jeopardize the vital prognosis of patient. White classification defines five types of endoleaks. Type III is secondary either to a disconnection between the components of the endoprosthesis (type IIIA) or to material damage (type IIIB). This type presents a particularly high risk of aortic rupture. Endovascular approach is the treatment of choice for this type of endoleaks through stent-grafts implantation. Type III endoleak may appear at any time after endovascular aortic aneurysm repair (EVAR). Although the frequency of endoleak after EVAR has been reduced after improvement and development of stent-graft systems, there are still many improvements and additions expected to improve the prognoses for patients after EVAR. Our case is an 80-year-old patient, who received an EVAR in 2012 for his abdominal aortic aneurysm, admitted to our vascular surgery department for a type III endoleak, for which he benefited from an endovascular treatment by placement of stent-grafts.
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Cantisani V, Di Leo N, David E, Clevert DA. Role of CEUS in Vascular Pathology. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:348-366. [PMID: 33915577 DOI: 10.1055/a-1403-2400] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.
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Affiliation(s)
- Vito Cantisani
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, "Sapienza" University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Nicola Di Leo
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, "Sapienza" University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Emanuele David
- Radiological Sciences, Radiology Unit, Papardo-Hospital, Messina, Italy, Messina, Italy
| | - Dirk-André Clevert
- Department of Clinical Radiology, University of Munich-Großhadern Campus, Munich, Germany
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3
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Faustino CB, Ventura C, Portugal MFC, Brunheroto A, Teivelis MP, Wolosker N. Experiência inicial com ultrassom Doppler com contraste por microbolhas em adição ao ultrassom Doppler convencional para seguimento de correção endovascular de aneurisma de aorta abdominal. J Vasc Bras 2021; 20:e20200093. [PMID: 35515084 PMCID: PMC9045535 DOI: 10.1590/1677-5449.200093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background Microbubble contrast enhanced ultrasound (CEUS) is an accurate diagnostic method for follow-up after endovascular abdominal aortic aneurysm repair (EVAR) that has been well-established in international studies. However, there are no Brazilian studies that focus on this follow-up method. Objectives The objective of this study was to report initial experience with CEUS at a tertiary hospital, comparing the findings of CEUS with those of conventional Doppler ultrasound (DUS), with the aim of determining whether addition of contrast to the standard ultrasonographic control protocol resulted in different findings. Methods From 2015 to 2017, 21 patients in follow-up after EVAR underwent DUS followed by CEUS. The findings of these examinations were analyzed in terms of identification of complications and their capacity to identify the origin of endoleaks. Results There was evidence of complications in 10 of the 21 cases examined: seven patients exhibited endoleaks (33.3%); two patients exhibited stenosis of a branch of the endograft (9.52%); and one patient exhibited a dissection involving the external iliac artery (4.76%). In the 21 patients assessed, combined use of both methods identified 10 cases of post-EVAR complications. In six of the seven cases of endoleaks (85.71%), use of the methods in combination was capable of identifying the origin of endoleakage. DUS alone failed to identify endoleaks in two cases (28.5%) and identified doubtful findings in another two cases (28.5%), in which diagnostic definition was achieved after employing CEUS. Conclusions CEUS is a technique that is easy to perform and provides additional support for follow-up of infrarenal EVAR.
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Affiliation(s)
| | | | | | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Brasil; Universidade de São Paulo, Brasil
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4
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Busoni C, Frigerio D. Contrast-Enhanced ultrasound in endovascular aneurysm repair follow-Up: Our experience. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_88_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kapetanios D, Kontopodis N, Mavridis D, McWilliams RG, Giannoukas AD, Antoniou GA. Meta-analysis of the accuracy of contrast-enhanced ultrasound for the detection of endoleak after endovascular aneurysm repair. J Vasc Surg 2019; 69:280-294.e6. [DOI: 10.1016/j.jvs.2018.07.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
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6
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Negrão de Figueiredo G, Müller-Peltzer K, Schwarze V, Rübenthaler J, Clevert DA. Ultrasound and contrast enhanced ultrasound imaging in the diagnosis of acute aortic pathologies. VASA 2018; 48:17-22. [PMID: 30403367 DOI: 10.1024/0301-1526/a000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Conventional ultrasound is worldwide the first-line imaging modality for the prompt diagnosis in the daily practice because it is a cost-effective and easy to perform technique. The additional application of contrast media has been used to enhance the intravascular contrast and to improve the imaging diagnostic accuracy in the detection, classification and follow-up of vascular pathologies. Contrast-enhanced ultrasound has the advantage of being a safe, fast and dynamic non-invasive imaging tool with excellent results in the diagnosis of acute aortic pathologies, especially the detection of endoleaks after endovascular aneurysm repair. This review describes the diagnostic and therapeutic roles of ultrasound and contrast-enhanced ultrasound imaging in the most common vascular pathologies such as aortic dissections, aneurysms and endoleaks. Keywords: Endoleak, contrast media, ultrasonography, aorta.
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Affiliation(s)
- Giovanna Negrão de Figueiredo
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Katharina Müller-Peltzer
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Vincent Schwarze
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
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7
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Francois CJ, Skulborstad EP, Majdalany BS, Chandra A, Collins JD, Farsad K, Gerhard-Herman MD, Gornik HL, Kendi AT, Khaja MS, Lee MH, Sutphin PD, Kapoor BS, Kalva SP. ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018; 15:S2-S12. [DOI: 10.1016/j.jacr.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/17/2022]
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8
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Cantisani V, David E, Ferrari D, Fanelli F, Di Marzo L, Catalano C, Benedetto F, Spinelli D, Katsargyris A, Blandino A, Ascenti G, D'Ambrosio F. Color Doppler Ultrasound with Superb Microvascular Imaging Compared to Contrast-enhanced Ultrasound and Computed Tomography Angiography to Identify and Classify Endoleaks in Patients Undergoing EVAR. Ann Vasc Surg 2017; 40:136-145. [DOI: 10.1016/j.avsg.2016.06.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/31/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022]
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9
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Cantisani V, Grazhdani H, Clevert DA, Iezzi R, Aiani L, Martegani A, Fanelli F, Di Marzo L, Wlderk A, Cirelli C, Catalano C, Di Leo N, Di Segni M, Malpassini F, D’Ambrosio F. EVAR: Benefits of CEUS for monitoring stent-graft status. Eur J Radiol 2015. [DOI: 10.1016/j.ejrad.2015.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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10
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Meyersohn NM, Avery LL. Imaging of iatrogenic conditions of the thorax. Radiol Clin North Am 2014; 52:913-28. [PMID: 25173652 DOI: 10.1016/j.rcl.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Common medical interventions performed by cardiologists, radiologists, surgeons, dentists, and alternative practitioners can result in complications within the thorax that lead to significant patient morbidity. Prompt radiologic identification of iatrogenic complications of medical procedures in the thorax is essential to guide patient triage and treatment. Understanding the approach to common thoracic interventions and the placement of thoracic medical devices can aid radiologists in the evaluation of iatrogenic complications.
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Affiliation(s)
- Nandini M Meyersohn
- Department of Diagnostic Radiology, Massachusetts General Hospital, 55 Fruit Street, FND 2-216, Boston, MA 02114, USA
| | - Laura L Avery
- Division of Emergency Radiology, Department of Diagnostic Radiology, Massachusetts General Hospital, 55 Fruit Street, FND 2-210, Boston, MA 02114, USA.
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Millen A, Canavati R, Harrison G, McWilliams RG, Wallace S, Vallabhaneni SR, Fisher RK. Defining a role for contrast-enhanced ultrasound in endovascular aneurysm repair surveillance. J Vasc Surg 2013; 58:18-23. [DOI: 10.1016/j.jvs.2012.12.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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12
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Clevert DA, Helck A, D’Anastasi M, Trumm C, Meimarakis G, Weidenhagen R, Kopp R, Jauch K, Reiser M. Ultraschallgesteuerte EVAR-Interventionen und Follow-up-Diagnostik mit der kontrastmittelgestützten Sonographie und der Bildfusion. GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00772-011-0892-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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The Significance of Endoleaks in Thoracic Endovascular Aneurysm Repair. Ann Vasc Surg 2011; 25:345-51. [DOI: 10.1016/j.avsg.2010.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/05/2010] [Accepted: 08/16/2010] [Indexed: 11/21/2022]
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14
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Prospective Comparative Analysis of Colour-Doppler Ultrasound, Contrast-enhanced Ultrasound, Computed Tomography and Magnetic Resonance in Detecting Endoleak after Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 41:186-92. [DOI: 10.1016/j.ejvs.2010.10.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 10/02/2010] [Indexed: 11/18/2022]
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15
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Stent thrombosis in aortic aneurysm: evaluation by multidetector CT. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Bastos RDM, Filho AR, Blasbalg R, Caffaro RA, Karakhanian W, Esteves FP, Romualdo AP, Rocha AJD. Trombose na endoprótese do aneurisma da aorta: avaliação por TC multidetector. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Endovascular aortic stent for thoracic and abdominal aortic aneurysm: imaging consequences and complications. ASIAN BIOMED 2010. [DOI: 10.2478/abm-2010-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Background: Endovascular stent-graft implantation has been used as an alternative to conventional open surgery in treatment of aortic aneurysm. Computed tomographic angiography (CTA) has been requested for follow-up and evaluation of aortic stent complications. Objective: Find the incidence of endovascular aortic stent complications and analyze the CTA features of postendovascular aortic stent consequences. Methods: Two radiologists reviewed CTA images of 635 patients who attended King Chulalongkorn Memorial Hospital between Sep 1, 2003 and Aug 31, 2008. Thirty-eight patients had endovascular aortic stent installation with 95 CTA images. The incidence of endovascular aortic stent complications, the image appearances including consequences and time-interval of endoleak were analyzed. Results: There were 23 thoracic aortic stents, 10 abdominal aortic stents and five combined stents for thoracic and abdominal aortic aneurysms. Twenty-eight cases had aortic stent complications (73.7%). Two cases had immediately post procedural complication of groin hematomas (7.1%). Ten patients had more than one finding. Findings of the stent-graft complications were as follows: 19 endoleaks, 15 stent thrombosis, five stents without covered-dissection, two stent kinkings, two iatrogenic focal aortic dissection, two air within aneurysm after stent installation and one spreading infected aortitis. The most common complication was endoleaks (53.6%), which could progress, be persistent or resolvable. Time-interval to detect endoleak was between 1 and 464 days. Conclusion: CTA can be used as modality of choice in demonstration of stent location, consequences, and complications. The stent complication was still high in the first five-year experience.
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Clevert DA, Horng A, Kopp R, Schick K, Meimarakis G, Sommer WH, Reiser M. [Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS)]. Radiologe 2010; 49:1033-9. [PMID: 19855950 DOI: 10.1007/s00117-009-1876-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue allows a rapid and non-invasive diagnosis in the follow-up after EVAR. The sensitivity and specificity of conventional ultrasound compared to the multislice CT angiography is estimated to be 33-63% and 63-93%, respectively. These values can be increased through the use of CEUS in up to 98-100% (sensitivity) and 82-93% (specificity). This article describes the etiology, classification and importance of different types of endoleaks. The value of CEUS in this clinical scenario will be discussed.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Volders D, Fourneau I, Daenens K, Houthoofd S, Maleux G, Nevelsteen A. Paraparesis after thoracic stent-graft relining for an unrecognized type III endoleak. Ann Vasc Surg 2010; 24:550.e5-9. [PMID: 20129755 DOI: 10.1016/j.avsg.2009.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 08/20/2009] [Accepted: 08/27/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND We examined the reasons for missing a type III endoleak on conventional imaging and the pathophysiology of paraparesis after relining this stent graft. METHODS AND RESULTS A 46-year-old man was treated with a thoracic stent graft for thoracic rupture of a chronic type B thoracoabdominal dissection with aneurysm formation. In a second intervention, retrograde revascularization of the visceral and renal arteries was performed in combination with insertion of an abdominal stent graft. After initial shrinkage of the aneurysmal sac, the thoracic aortic diameter started increasing again. Consecutive three-phase helical computed tomographic scans did not reveal any endoleak. Because of unbearable back pain, an open surgical exploration was performed. This showed a type III endoleak. Relining of the thoracic stent graft was performed, but paraparesis developed. CONCLUSION In patients with unexplained increase of the aneurysmal sac contrast-enhanced magnetic resonance imaging could help to illuminate the underlying endoleak. The collateral network concept can explain spinal cord injury by even minor hemodynamic changes.
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Affiliation(s)
- David Volders
- Department of Vascular Surgery, University Hospital Leuven, B-3000 Leuven, Belgium
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20
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Carrafiello G, Recaldini C, Laganà D, Piffaretti G, Fugazzola C. Endoleak detection and classification after endovascular treatment of abdominal aortic aneurysm: value of CEUS over CTA. ACTA ACUST UNITED AC 2008; 33:357-62. [PMID: 17619925 DOI: 10.1007/s00261-007-9268-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper focuses on the diagnostic value of CEUS in the detection and characterization of endoleaks in comparison with other imaging modalities, primary CDUS and CTA in the follow-up of endovascular abdominal aortic aneurysm repair. CEUS is an interesting alternative technique because of its limited costs and lack of exposure to ionizing radiation. However, CTA cannot currently be substituted because it enables a more precise evaluation of aneurysm morphologic changes, aneurysm sac diameter, graft anchorage and integrity. CEUS could be used along with CTA when the latter reveals the presence of endoleak, to provide a better characterization of it taking advantage of the angiodynamic behavior of the contrast agent that permits an easier visualization of the agent flow into the sac. It could also be indicated when aneurysm diameter increases and CTA did not show sac reperfusion or to monitor type II endoleaks reducing the use of CTA with consequent reduction of costs and exposure to radiation.
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Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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21
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Aneurysm Sac pressure measurement with minimally invasive implantable pressure sensors: an alternative to current surveillance regimes after EVAR? Cardiovasc Intervent Radiol 2007; 31:460-7. [PMID: 18087767 DOI: 10.1007/s00270-007-9245-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 10/30/2007] [Accepted: 11/08/2007] [Indexed: 10/22/2022]
Abstract
Current protocols for surveillance after endovascular repair (EVAR) of abdominal aortic aneurysms are mostly based on costly and time-consuming imaging procedures and aim to detect adverse events such as graft migration, endoleaks or aneurysm sac enlargement. These imaging procedures are either associated with radiation exposure to the patients or may be harmful to the patient due to the use of iodine- or gadolinium-containing contrast agents. Furthermore the advantages of EVAR in the short term might be negated by the necessity for endograft surveillance over years. Thus, alternative modalities for follow-up are being investigated. One of these technologies provides pressure information directly from the aneurysm sac. This noninvasive, telemetric pressure sensing was tested in vitro as well as in first clinical trials and was able to identify successful aneurysm exclusion after EVAR. The telemetric pressure sensors showed a promising efficacy and accuracy in detecting type I and type III endoleaks and will help to clarify the clinical relevance of type II endoleaks. This article provides an overview of the in vitro sensors investigated as well as the first clinical trials and the sensors' potential to change the current endograft surveillance regimes.
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Clevert DA, Stickel M, Flach P, Strautz T, Horng A, Jauch KW, Reiser M. Contrast-enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment. Cardiovasc Intervent Radiol 2007; 30:480-4. [PMID: 17205366 DOI: 10.1007/s00270-006-0143-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An aorto-caval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3-6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea, and an audible machinerylike bruit. Perioperative mortality is high, ranging from 20% to 60%. We report a case of an endovascular aortic repair in a patient with a symptomatic infrarenal aortic aneurysm and an aorto-caval fistula. Contrast-enhanced ultrasound seems to be a promising new diagnostic option for the diagnosis and preoperative treatment planning for patients with abdominal aortic aneurysms with rupture into the inferior vena cava. It is in addition to computed tomography angiography. It might allow a more rapid and noninvasive diagnosis, especially for patients in intensive care because of its bedside availability. Because the examination is dynamic, additional information about blood flow between the aorta and inferior cava vein can be evaluated.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.
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23
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Dill-Macky MJ, Wilson SR, Sternbach Y, Kachura J, Lindsay T. Detecting Endoleaks in Aortic Endografts Using Contrast-Enhanced Sonography. AJR Am J Roentgenol 2007; 188:W262-8. [PMID: 17312033 DOI: 10.2214/ajr.05.0532] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We performed this pilot study to investigate the utility of contrast-enhanced sonography for the detection of endoleaks in patients with abdominal aortic endografts. CONCLUSION Contrast-enhanced sonography evaluation of abdominal aortic endografts is a technically feasible alternative to our current practice standard.
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Affiliation(s)
- Marcus J Dill-Macky
- University Health Network, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 2M9, Canada
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Clevert DA, Stickel M, Johnson T, Glaser C, Clevert DA, Steitz HO, Kopp R, Jauch KW, Reiser M. Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 2007; 17:2991-3000. [PMID: 17219146 DOI: 10.1007/s00330-006-0542-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 10/25/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
Aortic abnormalities are commonly encountered and may represent a diagnostic challenge in patients with acute or chronic clinical symptoms. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a new promising method in the diagnosis and follow-up of pathological aortic lesions. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients because of its bedside availability. This review compares CEUS findings with those documented on computed tomography angiography (CTA), allowing the reader to appreciate the usefulness of CEUS in this clinical situation.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern, Munich, Germany.
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25
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Chernyak V, Rozenblit AM, Patlas M, Cynamon J, Ricci ZJ, Laks MP, Veith FJ. Type II Endoleak after Endoaortic Graft Implantation: Diagnosis with Helical CT Arteriography. Radiology 2006; 240:885-93. [PMID: 16868280 DOI: 10.1148/radiol.2403051013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess endoleak shapes and locations within aneurysms to differentiate type II from type I and type III endoleaks. MATERIALS AND METHODS The institutional review board granted an exemption for this HIPAA-compliant study; patient informed consent was not required. A retrospective review of arterial phase helical computed tomographic (CT) studies and medical records was performed for 39 patients (29 men, 10 women; age range, 60-89 years; mean, 78.5 years) who had an endoleak after endoaortic graft implantation for treatment of abdominal aortic aneurysm and who subsequently underwent angiography (n = 25), surgery (n = 8), or long-term follow-up (n = 6) to classify their endoleak into a specific type. At CT, endoleak shape (tubular or nontubular) and location (central or peripheral) were recorded. An endoleak was classified as type II if it contained a peripheral tubular component (PTC) near the aortic wall, with or without an identifiable feeding vessel. Endoleaks without these features were classified as type I or III. The Fisher exact test was used to assess associations between CT findings and endoleak type. RESULTS There were 22 type II and 17 type I or III endoleaks. CT enabled correct identification of 22 (100%) of 22 type II endoleaks, all of which contained a PTC. Of 17 type I or III endoleaks, only two (12%) contained a PTC and were misclassified as type II endoleaks; the remaining 15 (88%) were correctly classified. Overall, CT enabled correct identification of endoleaks as type II or type I or III in 37 (95%) of 39 patients. PTCs were significantly more common (P < .001) in type II than in type I or III endoleaks, with a sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 100%, 88.2%, 94.9%, 100%, and 91.7%, respectively. CONCLUSION A PTC is a statistically significant predictor of type II endoleak in most patients.
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Affiliation(s)
- Victoria Chernyak
- Departments of Radiology and Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA.
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Carrafiello G, Laganà D, Recaldini C, Mangini M, Bertolotti E, Caronno R, Tozzi M, Piffaretti G, Genovese EA, Fugazzola C. Comparison of Contrast-Enhanced Ultrasound and Computed Tomography in Classifying Endoleaks After Endovascular Treatment of Abdominal Aorta Aneurysms: Preliminary Experience. Cardiovasc Intervent Radiol 2006; 29:969-74. [PMID: 16897267 DOI: 10.1007/s00270-005-0267-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of the study was to assess the effectiveness of contrast-enhanced ultrasonography (CEUS) in endoleak classification after endovascular treatment of an abdominal aortic aneurysm compared to computed tomography angiography (CTA). From May 2001 to April 2003, 10 patients with endoleaks already detected by CTA underwent CEUS with Sonovue to confirm the CTA classification or to reclassify the endoleak. In three conflicting cases, the patients were also studied with conventional angiography. CEUS confirmed the CTA classification in seven cases (type II endoleaks). Two CTA type III endoleaks were classified as type II using CEUS and one CTA type II endoleak was classified as type I by CEUS. Regarding the cases with discordant classification, conventional angiography confirmed the ultrasound classification. Additionally, CEUS documented the origin of type II endoleaks in all cases. After CEUS reclassification of endoleaks, a significant change in patient management occurred in three cases. CEUS allows a better attribution of the origin of the endoleak, as it shows the flow in real time. CEUS is more specific than CTA in endoleak classification and gives more accurate information in therapeutic planning.
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Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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de Gracia MM, Rodríguez-Vigil B, Garzón-Möll G, Bravo-Soberón A, Sánchez-Almaraz C, Alvarez-Sala-Walther R. Correlation between the Measurement of Transverse Diameter in the Proximal Neck on Computed Tomography and on Aortography before Endovascular Treatment of Infrarenal Aortic Aneurysm. Ann Vasc Surg 2006; 20:488-95. [PMID: 16791456 DOI: 10.1007/s10016-006-9077-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 04/07/2006] [Accepted: 04/10/2006] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the correlation between the measurement of transverse diameter of the proximal neck on computed tomographic angiography (CTA) and graduated catheter aortography in patients who are candidates for endovascular graft placement in order to replace, if both measurements are equivalent, aortography for CTA alone. Preoperative dual-slice CTA and graduated catheter aortography were performed in 35 consecutive patients with infrarenal aortic aneurysm within 10 days. Transverse proximal neck diameters were measured on a true axial section on CTA reconstructions and on aortographic images, always 6 mm distal from the most inferior main renal artery. Mean, median, and standard deviation were obtained and the measurements correlated for each patient using Pearson's correlation and linear regression analysis. A significant difference in proximal neck transverse diameter measurements was found between graduated catheter aortography and CTA in all cases. CTA values were a mean of 1.74 mm higher than aortography values. Pearson's correlation indicates a strong correlation between both techniques, and a regression equation determines the predictive value of aortography on the basis of CTA values. Estimation of the transverse diameter of the proximal neck on aortography on the basis of that obtained on CTA allows us to affirm that CTA could be used as the sole method for the preoperative selection of appropriate endograft size in patients with infrarenal aortic aneurysm.
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Stavropoulos SW, Marin H, Fairman RM, Carpenter JP, Litt HI, Itkin M, Clark TWI. Recurrent endoleak detection and measurement of aneurysm size with CTA after coil embolization of endoleaks. J Vasc Interv Radiol 2006; 16:1313-7. [PMID: 16221901 DOI: 10.1097/01.rvi.0000175900.61777.9a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The optimal modality for following aneurysm size and detecting endoleaks after endovascular aneurysm repair (EVAR) remains controversial. Computed tomographic angiography (CTA) has been widely employed but can be limited by metal artifact from stents, which is exacerbated by embolization coils placed during the treatment of type 2 endoleaks. The authors assessed interobserver agreement of CTA for measuring aneurysm size and presence of recurrent endoleak in patients with prior coil embolization of type 2 endoleaks. MATERIALS AND METHODS A total of 65 CTAs were retrospectively reviewed in a cohort of 27 patients (25 men; two women; mean age, 77.4 years) who had prior endoleak embolization after EVAR. Endoleak embolizations included transarterial (n=8) and translumbar (n=19) approaches. In each patient, maximal aneurysm diameter and presence/absence of recurrent endoleak was measured independently by two observers. Cohen's Kappa statistic was used to assess interobserver agreement, as well as paired two-tailed Student t tests for aneurysm diameter. RESULTS Recurrent type 2 endoleaks were detected with CTA in eight of 27 patients (30%) and on 13 of 65 CTAs (20%). A high degree of correlation (98.5%) was also seen between the two observers for presence of endoleak (Kappa=0.95). Mean aneurysm diameter for the entire cohort correlated closely between both observers: 54.8 mm+/-1.1 for observer A and 54.9 mm+/-1.1 for observer B (P=.66). There was a disagreement between the readers of greater than 2 mm regarding aneurysm size in 13.8% of the CTAs (nine of 65 CTAs). CONCLUSION Despite the presence of streak artifact on CTA following coil embolization of type 2 endoleaks, CTA remains a useful study for following patients. The presence of embolization coils does not prevent CTA measurement of aneurysm diameter and detection of recurrent endoleak with a high degree of interobserver agreement.
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Affiliation(s)
- S William Stavropoulos
- Department of Radiology, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Pitton MB, Schweitzer H, Herber S, Schmiedt W, Neufang A, Kalden P, Thelen M, Düber C. MRI versus helical CT for endoleak detection after endovascular aneurysm repair. AJR Am J Roentgenol 2006; 185:1275-81. [PMID: 16247149 DOI: 10.2214/ajr.04.0729] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to investigate the diagnostic accuracy of MRI and helical CT for endoleak detection. SUBJECTS AND METHODS Fifty-two patients underwent endovascular aneurysm repair with nitinol stent-grafts. Follow-up data sets included contrast-enhanced biphasic CT and MRI within 48 hr after the intervention; at 3, 6, and 12 months; and yearly thereafter. The endoleak size was categorized as < or = 3%, > 3% < or = 10%, > 10% < or = 30%, or > 30% of the maximum cross-sectional aneurysm area. A consensus interpretation of CT and MRI was defined as the standard of reference. RESULTS Of 252 data sets, 141 showed evidence for endoleaks. The incidence of types I, II, and III endoleaks and complex endoleaks was 3.2%, 40.1%, 8.7%, and 4.0%, respectively. The sensitivity for endoleak detection was 92.9%, 44.0%, 34.8%, and 38.3% for MRI, biphasic CT, uniphasic arterial CT, and uniphasic late CT, respectively. The corresponding negative predictive values were 91.7%, 58.4%, 54.7%, and 56.1%, respectively. The overall accuracy of endoleak detection and correct sizing was 95.2%, 58.3%, 55.6%, and 57.1% for MRI, biphasic CT, uniphasic arterial CT, and uniphasic late CT, respectively. CONCLUSION MRI is significantly superior to biphasic CT for endoleak detection and rating of endoleak size, followed by uniphasic late and uniphasic arterial CT scans. MRI shows a significant number of endoleaks in cases with negative CT findings and may help illuminate the phenomenon of endotension. Endoleak rates reported after endovascular aneurysm repair substantially depend on the imaging techniques used.
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Affiliation(s)
- Michael B Pitton
- Department of Radiology, University Hospital of Mainz, Langenbeckstrasse 1, Mainz 55131, Germany.
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Jones E, Nafiu B, Amankwah K, Pollak JS, Gusberg RJ, Dardik A. Use of N-acetylcholine and sodium bicarbonate to protect renal transplant function during endovascular renal artery aneurysm exclusion. Vascular 2005; 13:301-4. [PMID: 16288706 DOI: 10.1258/rsmvasc.13.5.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the successful use of hydration with sodium bicarbonate and N-acetylcholine to prevent contrast-induced nephrophathy in a patient with a kidney transplant undergoing endovascular native renal artery aneurysm exclusion. The implications for surveillance studies for endovascular procedures are discussed.
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Affiliation(s)
- Emlyn Jones
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Bargellini I, Cioni R, Petruzzi P, Pratali A, Napoli V, Vignali C, Ferrari M, Bartolozzi C. Endovascular Repair of Abdominal Aortic Aneurysms: Analysis of Aneurysm Volumetric Changes at Mid-Term Follow-Up. Cardiovasc Intervent Radiol 2005; 28:426-33. [PMID: 16010509 DOI: 10.1007/s00270-004-0171-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the volumetric changes in abdominal aortic aneurysms (AAA) after endovascular AAA repair (EVAR) in 24 months of follow-up. METHODS We evaluated the volume modifications in 63 consecutive patients after EVAR. All patients underwent strict duplex ultrasound and computed tomography angiography (CTA) follow-up; when complications were suspected, digital subtraction angiography was also performed. CTA datasets at 1, 6, 12, and 24 months were post-processed through semiautomatic segmentation, to isolate the aneurysmal sac and calculate its volume. Maximum transverse diameters (Dmax) were also obtained in the true axial plane, Presence and type of endoleak (EL) were recorded. A statistical analysis was performed to assess the degree of volume change, correlation with diameter modifications, and significance of the volume increase with respect to ELs. RESULTS Mean reconstruction time was 7 min. Mean volume reduction rates were 6.5%, 8%, and 9.6% at 6, 12, and 24 months follow-up, respectively. Mean Dmax reduction rates were 4.2%, 6.7%, and 12%; correlation with volumes was poor (r = 0.73-0.81). ELs were found in 19 patients and were more frequent (p = 0.04) in patients with higher preprocedural Dmax, The accuracies of volume changes in predicting ELs ranged between 74.6% and 84.1% and were higher than those of Dmax modifications. The strongest independent predictor of EL was a volume change at 6 months < or = 0.3% (p = 0.005), although 6 of 19 (32%) patients with EL showed no significant AAA enlargement, whereas in 6 of 44 (14%) patients without EL the aneurysm enlarged. CONCLUSION The lack of volume decrease in the aneurysm of at least 0.3% at 6 months follow-up indicates the need for closer surveillance, and has a higher predictive accuracy for an endoleak than Dmax.
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Affiliation(s)
- Irene Bargellini
- Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy.
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El-Saeity N, Benfayed W, Ramesh N, Feeley M, Torreggiani WC. Direct thrombin injection into aneurysmal sac in a patient with a type II endoleak. ACTA ACUST UNITED AC 2005; 48:418-20. [PMID: 15345000 DOI: 10.1111/j.0004-8461.2004.01332.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Endovascular grafting of abdominal aortic aneurysms provides a good alternative to open surgery, especially in high-risk patients. Endoleaks are a well-recognized complication and are typically diagnosed on CT. We describe a case in which a patient's endoleak was evaluated by MRI and successfully treated by direct thrombin injection into the site of the leak.
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Affiliation(s)
- N El-Saeity
- Department of Radiology, Adelaide and Meath Incorporating National Children's Hospital, Tallaght, Dublin, Ireland
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McGuigan EA, Sears ST, Corse WR, Ho VB. MR Angiography of the Abdominal Aorta. Magn Reson Imaging Clin N Am 2005; 13:65-89, v-vi. [PMID: 15760757 DOI: 10.1016/j.mric.2004.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth A McGuigan
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Baum RA, William Stavropoulous S. Management of Type II Endoleaks: Embolization, Sac, Injection and Watchful Waiting. J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
At the present time, patients who have undergone endovascular aneurysm repair require lifelong surveillance. The purpose of this surveillance is threefold. First, has there been any change in the position of the endograft? Secondly, what is the status of the aneurysm sac? Thirdly, is there an endoleak? How the patient is managed depends on the answers to these three questions. Managing patients with endoleaks remains a challenging clinical problem. Decisions on these patients depend on the type of leak and the status of the aneurysm sac. This manuscript will review what is currently known about endoleaks and use this information to develop algorithms of how patients should be treated.
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Abstract
Endovascular aneurysm repair has proven to be a valuable alternative to open repair in selected patients. This less invasive procedure, however, requires long-term surveillance for its own set of potential complications, including perigraft leakage, or endoleak. This article focuses on the detection of these leaks, first defining and classifying endoleaks and then describing various means of detecting them, including computed tomographic angiography, magnetic resonance angiography, color-flow duplex ultrasonography, and conventional angiography.
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Affiliation(s)
- Mark D Hiatt
- Department of Radiology, Stanford University Medical Center, Stanford, CA 94305-5105, USA
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Napoli V, Bargellini I, Sardella SG, Petruzzi P, Cioni R, Vignali C, Ferrari M, Bartolozzi C. Abdominal Aortic Aneurysm: Contrast-enhanced US for Missed Endoleaks after Endoluminal Repair. Radiology 2004; 233:217-25. [PMID: 15454621 DOI: 10.1148/radiol.2331031767] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate contrast material-enhanced ultrasonography (US) for depiction of endoleaks after endovascular abdominal aortic aneurysm repair (or endovascular aneurysm repair [EVAR]) in patients with aneurysm enlargement and no evidence of endoleak. MATERIALS AND METHODS From November 1998 to February 2003, 112 patients underwent EVAR. At follow-up, duplex US and biphasic multi-detector row computed tomographic (CT) angiography were performed. In 10 patients (group A), evident aneurysm enlargement was observed, with no evidence of complications, at both CT angiography and duplex US. Group A patients, 10 men (mean age, 69.6 years +/- 10 [standard deviation]), underwent US after intravenous bolus injection of a second-generation contrast agent, with continuous low-mechanical index (0.01-0.04) real-time tissue harmonic imaging. Group B patients, 10 men (mean age, 71.3 years +/- 8.2) with aneurysm shrinkage and no evidence of complications, and group C patients, 10 men (mean age, 73.2 years +/- 6) with CT angiographic evidence of endoleak, underwent contrast-enhanced US. Digital subtraction angiography (DSA) was performed in groups A and C. Endoleak detection and characterization were assessed with imaging modalities used in groups A-C; at contrast-enhanced US, time of detection of endoleak, persistence of sac enhancement, and morphology of enhancement were evaluated. RESULTS In group A, contrast-enhanced US depicted one type I, six type II, one type III, and two undefined endoleaks that were not detected at CT angiography. All leakages were characterized by slow and delayed echo enhancement detected at longer than 150 seconds after contrast agent administration. DSA results confirmed findings in all patients; percutaneous treatment was performed. In group B, contrast-enhanced US did not show echo enhancement; in group C, results with this modality confirmed findings at CT angiography and DSA. CONCLUSION Contrast-enhanced US depicts endoleaks after EVAR, particularly when depiction fails with other imaging modalities.
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MESH Headings
- Aged
- Aged, 80 and over
- Angiography
- Angiography, Digital Subtraction
- Angioplasty
- Aorta, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/surgery
- Blood Vessel Prosthesis
- Contrast Media
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Phospholipids
- Postoperative Complications/diagnostic imaging
- Prosthesis Design
- Stents
- Sulfur Hexafluoride
- Tomography, Spiral Computed
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Duplex
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Affiliation(s)
- Vinicio Napoli
- Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology and Department of Vascular Surgery, University of Pisa, Via Roma 67, 56126 Pisa, Italy
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Milner R, Ruurda JP, Blankensteijn JD. Durability and Validity of a Remote, Miniaturized Pressure Sensor in an Animal Model of Abdominal Aortic Aneurysm. J Endovasc Ther 2004; 11:372-7. [PMID: 15298503 DOI: 10.1583/04-1229.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate whether a remote, miniaturized pressure sensor could maintain calibration and function through organized thrombus over an extended period in a porcine model of abdominal aortic aneurysm (AAA). METHODS Six adult pigs had an AAA surgically created and excluded. A sensor zeroed to atmospheric pressure was placed within the aneurysm sac and another within the suprarenal aorta of each animal. Pressure measurements were taken at the initial operation and then on a weekly basis over 2 months. The aortic sensors were correlated to an intra-arterial pressure catheter at the initial operation and at the time of sacrifice. Back-table sensor correlation with atmospheric pressure was done at the time of explantation. RESULTS Three animals died during the follow-up period. Five animals were available for 6-week follow-up, of which 3 survived for the complete 8-week protocol. Two of the surviving animals had an intra-aortic sensor. All 5 aneurysm sac sensors functioned throughout the experimental period. At the time of sacrifice, the sacs contained a large amount of organized thrombus in which the sac sensors were deeply embedded. The 3 aortic sensors also functioned throughout the course of the experiments. The pressures correlated within 5 mmHg to the catheter-based measurements taken at the initial operation and at the time of sacrifice. Comparison to atmospheric pressure revealed no calibration offset in any sensor. CONCLUSIONS This chronic implantation study demonstrates the durability of a remote, miniaturized pressure sensor within a surgically created aneurysm sac as well as the suprarenal aorta of a porcine AAA model. There was no calibration offset in any of the sensors, and they remained valid at explantation. We believe that this is further evidence of the potential applicability of this sensor for clinical use.
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Affiliation(s)
- Ross Milner
- Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Abstract
Although endovascular aneurysm repair (EVAR) has shown promising initial results, there are unique complications to this procedure. Endoleaks, which do not occur after traditional surgical repair of abdominal aortic aneurysms, are detected in patients undergoing EVAR and are thought by some to be one of the limitations of this procedure. Endoleaks may continue to perfuse and pressurize the aneurysm sac, thereby conferring an ongoing risk of aneurysm enlargement and/or rupture. Because of this, accurate endoleak detection and classification is essential following EVAR. Surveillance of patients is critical to determine the long-term performance of the stent grafts. Although this is usually accomplished with contrast-enhanced spiral computed tomography scans performed at regular intervals, duplex ultrasonography exams; magnetic resonance angiography; and digital subtraction angiography all have a role in endoleak detection and classification. This article will cover imaging modalities used to detect endoleaks. In addition, we will cover which imaging exams should be performed to help with endoleak management.
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Endoleak: What Works? J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Diagnosis and Classification of Endoleaks. J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hansen CJ, Kim B, Aziz I, Enriquez IA, Donayre C, Kopchok G, Walot I, Lippmann M, White RA. Late-onset Type II Endoleaks and the Incidence of Secondary Intervention. Ann Vasc Surg 2004; 18:26-31. [PMID: 14712377 DOI: 10.1007/s10016-003-0098-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Type II endoleaks are a recognized complication of endoluminal treatment of abdominal aortic aneurysms. In order to better understand the natural history of type II endoleaks and their influence on secondary procedures, we examined our experience with patients who developed isolated type II endoleaks 6 months or more after their original procedure. We conducted a retrospective review of patients who underwent endoluminal repair of infrarenal abdominal aortic aneurysms with bifurcated endoluminal devices at a single institution from June 1996 to June 2000. Endoleak surveillance was performed on all patients by using a defined CT angiogram protocol. Patients with definitive and isolated type II endoleaks on CT angiogram were identified. Patients with indeterminate endoleaks or a combination of different types of endoleaks were excluded. Data were analyzed on the basis of early (<6 months) or late occurrence of isolated type II endoleak. Fifty patients were identified with isolated type II endoleaks. Of these patients, 20 (40%) had endoleaks discovered before the 6-month follow-up interval whereas the majority (60%) had new type II leaks discovered at least 6 months after their initial procedure. The timing of endoleak occurrence did not significantly influence the rate of spontaneous endoleak resolution between the early- (<6 months) and late-onset (>6 months) groups, which was nearly identical (40% vs. 43%). Ten patients in the early group and seven of the late-onset group required secondary intervention for treatment of type II endoleak (50% vs. 23%; NS). Three patients in the early group underwent surgical conversion (vs. 0 patients in the late-onset group). The mortality rate was not significantly different between groups (15% vs. 7%). Most isolated type II endoleaks in this patient population occurred 6 months or more after initial endoluminal repair of infrarenal abdominal aortic aneurysm. Timing of type II endoleak occurrence did not significantly affect the rates of spontaneous resolution or mortality. Although differences were observed in the number of patients receiving secondary interventions, these findings did not reach statistical difference. All patients who required surgical conversion had early type II endoleaks. There were no observed ruptures in patients with increased aneurysm size treated with secondary intervention or those with stable aneurysm volumes who were followed without intervention. The continued development of type II endoleaks beyond the perioperative period supports the need for continued endoleak surveillance.
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Affiliation(s)
- Christopher J Hansen
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA
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Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP. Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2003; 14:1111-7. [PMID: 14514802 DOI: 10.1097/01.rvi.0000085773.71254.86] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Endovascular repair of abdominal aortic aneurysms shows promising initial results. Endoleaks represent one of the unique causes of endovascular repair failure not seen with traditional abdominal aortic aneurysm repair. Endoleaks occur when there is blood flow outside the stent-graft lumen but within the aneurysm sac. They can be difficult to diagnose and treat, and their management is a source of continued controversy. This review further defines endoleaks and the clinical challenges that they create. Current methods for endoleak detection, classification, and management are reviewed.
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Affiliation(s)
- Richard A Baum
- Section of Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.
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Insko EK, Kulzer LM, Fairman RM, Carpenter JP, Stavropoulos SW. MR imaging for the detection of endoleaks in recipients of abdominal aortic stent-grafts with low magnetic susceptibility. Acad Radiol 2003; 10:509-13. [PMID: 12755539 DOI: 10.1016/s1076-6332(03)80060-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES This study was performed to assess the efficacy of magnetic resonance (MR) imaging for the detection of endoleaks in recipients of abdominal aortic stent-grafts with low magnetic susceptibility. MATERIALS AND METHODS A retrospective search was conducted in radiology department records for cases of patients with low-susceptibility stent-grafts who had been evaluated with MR imaging and either computed tomography (CT) or conventional angiography within a 1-month time frame. Any endoleaks previously confirmed and classified with the use of CT and/or conventional angiography were compared with findings from MR imaging. RESULTS Nine patients fit the selection criteria. Images of five of those patients depicted six different endoleaks. Two endoleaks had been confirmed with CT, another two had been confirmed with CT and angiography, and two had been confirmed with angiography alone. All endoleaks visualized at CT and/or angiography were accurately detected and classified also with MR imaging. In some cases, the endoleak was more clearly visualized with MR imaging than with CT. In four patients in whom no endoleaks were found at CT, MR imaging also indicated no endoleaks. CONCLUSION MR imaging is a suitable modality for identifying endoleaks in patients with low-susceptibility stent-grafts. Moreover, MR imaging may be more sensitive than CT for the detection of small endoleaks.
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Affiliation(s)
- Erik K Insko
- Department of Radiology Hospital, University of Pennsylvania, MRI, 1 Founders Bldg, 3400 Spruce St, Philadelphia, PA 19104-4283, USA
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Kaufman JA. Imaging Endoleaks: CT, US, MR or Angio? J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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