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Kargul M, Skórka P, Gutowski P, Kazimierczak A, Wiernicki I, Rynio P. Beyond Diameter: Enhancing Abdominal Aortic Aneurysm Surveillance with Volumetric Assessments after Endovascular Aneurysm Repair (EVAR). J Clin Med 2023; 12:6733. [PMID: 37959199 PMCID: PMC10648027 DOI: 10.3390/jcm12216733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to investigate the relationship between maximum transverse diameter (MTD) and volume measurements in patients who underwent reoperations after endovascular aneurysm repair (EVAR), and their association with the occurrence of endoleaks. The study included 51 patients who underwent EVAR and subsequent re-operations caused by endoleaks type I-III. In some number of events, multiple re-operations were needed. MTD was measured using the Horos software, and segmentations of the AAA were performed using 3D Slicer. This study first evaluated post-operative computed tomography angiography (CTA) to measure MTD and volume. Then, similar measurements were made in the control scan for re-operation qualification. Negative remodeling (increase in MTD and/or volume) was observed in 40 cases using MTD, and 48 cases using volume measurements. The volume measurement showed lower missed negatives than MTD, indicating its effectiveness in screening for negative remodeling (p < 0.001). Combining both methods identified 51 negative remodeling cases and 8 positive changes, with a higher sensitivity compared to MTD alone. The volume of the sac did not predict specific endoleak types. Decreases in MTD were observed in smaller sacs, with smaller volume changes. Volume measurement is a valuable screening tool, and combining MTD and volume enhances sensitivity. However, sac volume does not predict endoleak type.
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Affiliation(s)
- Michał Kargul
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland (I.W.)
| | | | | | | | | | - Paweł Rynio
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland (I.W.)
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Bogdanovic M, Siika A, Lindquist Liljeqvist M, Gasser TC, Hultgren R, Roy J. Biomechanics and Early Sac Regression after Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm. JVS Vasc Sci 2023; 4:100104. [PMID: 37152845 PMCID: PMC10160496 DOI: 10.1016/j.jvssci.2023.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Background Sac regression after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) is regarded as a marker of successful response to treatment. Several factors influence sac behavior after EVAR, yet little is known about the value of preoperative biomechanics. The aim of this study was to investigate the difference in aortic biomechanics between patients with and without sac regression. Methods Patients treated with standard EVAR for infrarenal AAA at the Karolinska University Hospital between 2009 and 2012 with one preoperative and a minimum of two postoperative computed tomography angiography (CTA) scans were considered for inclusion in this single-center retrospective cohort study. Biomechanical indices such as AAA wall stress and wall stress-strength ratio as well as intraluminal thrombus (ILT) thickness and stress were measured preoperatively in A4ClinicRE (VASCOPS GmbH). AAA diameter and volume were analyzed on preoperative, 30-day, and 1-year CTAs. Patients were dichotomized based on sac regression, defined as a ≥ 5 mm decrease in maximal AAA diameter between the first two postoperative CTA scans. Multivariable logistic regression was used for analysis of factors associated with early sac regression. Results Of the 101 patients treated during the inclusion period, 64 were included. Thirty-nine (61%) demonstrated sac regression and 25 (39%) had a stable sac or sac increase. The mean patients age (73 years vs 76 years), male sex (85% vs 96%), and median AAA diameter (58 mm vs 58.5 mm) did not differ between patients with and without sac regression. Although no difference in preoperative biomechanics was seen between the groups, multivariable logistic regression revealed that a larger AAA diameter (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.06-1.51; P = .009) and smoking (OR, 22.1; 95% CI, 2.78-174; P = .003) were positively associated with sac regression. In contrast, the lumen diameter (OR, 0.87; 95% CI, 0.77-0.98; P = .023), ILT thickness (OR, 0.85; 95% CI, 0.75-0.97; P = .013), aspirin or direct-acting oral anticoagulant use (OR, 0.11; 95% CI, 0.02-0.61; P = .012), and mean ILT stress (OR, 0.35; 95% CI, 0.14-0.87; P = .024) showed a negative association. Patients with sac regression had fewer reinterventions (log-rank P = .010) and lower mortality (log-rank P = .012) at the 5-year follow-up. Conclusions This study, characterizing preoperative biomechanics in patients with and without sac regression, demonstrated a negative association between mean ILT stress and ILT thickness with a change in sac diameter after EVAR. Given that the ILT is a highly dynamic entity, further studies focusing on the role of the thrombus are needed. Furthermore, patients presenting with early sac regression had improved outcomes after EVAR.
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Hemostatic Biomarkers and Volumetry Help to Identify High-Risk Abdominal Aortic Aneurysms. Life (Basel) 2022; 12:life12060823. [PMID: 35743854 PMCID: PMC9225361 DOI: 10.3390/life12060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Predicting the progression of small aneurysms is a main challenge in abdominal aortic aneurysm (AAA) management. The combination of circulating biomarkers and image techniques might provide an alternative for risk stratification. We evaluated the association of plasma TAT complexes (TAT) and D-dimer with AAA severity in 3 groups of patients: group 1, without AAA (n = 52), group 2, AAA 40−50 mm (n = 51) and group 3, AAA > 50 mm (n = 50). TAT (p < 0.001) and D-dimer (p < 0.001) were increased in patients with AAA (groups 2 and 3) vs. group 1. To assess the association between baseline TAT and D-dimer concentrations, and AAA growth, aortic diameter and volume (volumetry) were measured by computed tomography angiography (CTA) in group 2 at recruitment (baseline) and 1-year after inclusion. Baseline D-dimer and TAT levels were associated with AAA diameter and volume variations at 1-year independently of confounding factors (p ≤ 0.044). Additionally, surgery incidence, recorded during a 4-year follow-up in group 2, was associated with larger aneurysms, assessed by aortic diameter and volumetry (p ≤ 0.036), and with elevated TAT levels (sub-hazard ratio 1.3, p ≤ 0.029), while no association was found for D-dimer. The combination of hemostatic parameters and image techniques might provide valuable tools to evaluate AAA growth and worse evolution.
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Caradu C, Pouncey AL, Lakhlifi E, Brunet C, Bérard X, Ducasse E. Fully automatic volume segmentation using deep learning approaches to assess aneurysmal sac evolution after infra-renal endovascular aortic repair. J Vasc Surg 2022; 76:620-630.e3. [PMID: 35618195 DOI: 10.1016/j.jvs.2022.03.891] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) surveillance relies on serial measurements of maximal diameter despite significant inter- and intra-observer variability. Volumetric measurements are more sensitive but general use is hampered by the time required for their implementation. An innovative fully automated software (PRAEVAorta® from Nurea), using artificial intelligence (AI), previously demonstrated fast and robust detection of infra-renal abdominal aortic aneurysm's (AAA) characteristics on pre-operative imaging. This study aimed to assess the robustness of these data on post-EVAR computed tomography (CT) scans. METHODS Comparison was made between fully automatic and semi-automatic segmentation manually corrected by a senior surgeon on a dataset of 48 patients (48 early post-EVAR CT scans with 6466 slices, and a total of 101 follow-up CT scans with 13708 slices). RESULTS The analyses confirmed an excellent correlation of post-EVAR volumes and surfaces, as well as, proximal neck and maximum aneurysm diameters measured with the fully automatic and manually corrected segmentation methods (Pearson's coefficient correlation >.99, p<.0001). Comparison between the fully automatic and manually corrected segmentation method revealed a mean Dice Similarity Coefficient of 0.950±0.015, Jaccard index of 0.906±0.028, Sensitivity of 0.929±0.028, Specificity of 0.965±0.016, Volumetric Similarity (VS) of 0.973±0.018 and mean Hausdorff Distance/slice of 8.7±10.8mm. The mean VS reached 0.873±0.100 for the lumen and 0.903±0.091 for the thrombus. The segmentation time was 9 times faster with the fully automatic method (2.5 vs 22 min/patient with the manually corrected method; p<.0001). Preliminary analysis also demonstrated that a diameter increase of 2mm can actually represent >5% volume increase. CONCLUSION PRAEVAorta® enables a fast, reproducible, and fully automated analysis of post-EVAR AAA sac and neck characteristics, with comparison between different time points. It could become a crucial adjunct for EVAR follow-up through early detection of sac evolution, which may reduce the risk of secondary rupture.
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Affiliation(s)
- Caroline Caradu
- Bordeaux University Hospital, department of vascular surgery, 33000 Bordeaux, France
| | | | - Emilie Lakhlifi
- Bordeaux University Hospital, department of vascular surgery, 33000 Bordeaux, France
| | - Céline Brunet
- Bordeaux University Hospital, department of vascular surgery, 33000 Bordeaux, France
| | - Xavier Bérard
- Bordeaux University Hospital, department of vascular surgery, 33000 Bordeaux, France
| | - Eric Ducasse
- Bordeaux University Hospital, department of vascular surgery, 33000 Bordeaux, France.
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Hu G, Ding N, Wang Z, Jin Z. The association of body composition with abdominal aortic aneurysm growth after endovascular aneurysm repair. Insights Imaging 2022; 13:76. [PMID: 35467156 PMCID: PMC9038972 DOI: 10.1186/s13244-022-01187-7] [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: 12/24/2021] [Accepted: 02/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Body composition (BC) may be associated with abdominal aortic aneurysm (AAA) growth, but the results of previous research are contradictory. This study aimed to explore the relationship between BC and postoperative aneurysm progression.
Methods
Patients with regular postoperative follow-ups were retrospectively identified. The volume change of the aneurysm was measured to evaluate AAA progression. After segmenting different body components (subcutaneous fat, visceral fat, pure muscle, and intramuscular fat), the shape features and gray features of these tissues were extracted. Uni- and multivariable methods were used to analyze the relationship between imaging features of BC and AAA growth.
Results
A total of 94 patients (68 ± 8 years) were eligible for feature analyses. Patients with expansive aneurysms (29/94; volume change > 2%) were classified into Group(+) and others with stable or shrunken aneurysms (65/94) were classified into Group(−). Compared with Group(+), Group(−) showed a higher volume percent of pure muscle (21.85% vs 19.51%; p = .042) and a lower value of intramuscular fat (1.23% vs 1.65%; p = .025). CT attenuation of muscle tissues of Group(−) got a higher mean value (31.16 HU vs 23.92 HU; p = .019) and a lower standard deviation (36.12 vs 38.82; p = .006) than Group(+). For adipose tissue, we found no evidence of a difference between the two groups. The logistic regression model containing muscle imaging features showed better discriminative accuracy than traditional factors (84% vs 73%).
Conclusions
Muscle imaging features are associated with the volume change of postoperative aneurysms and can make an early prediction. Adipose tissue is not specifically related to AAA growth.
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Franchin M, Serafini M, Tadiello M, Fontana F, Rivolta N, Venturini M, Curti M, Bush RL, Dorigo W, Piacentino F, Tozzi M, Piffaretti G. A morphovolumetric analysis of aneurysm sac evolution after elective endovascular abdominal aortic repair. J Vasc Surg 2021; 74:1222-1231.e2. [PMID: 33864827 DOI: 10.1016/j.jvs.2021.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) sac shrinkage after endovascular aortic repair (EVAR) has been regarded as positive marker of EVAR success durability. The purpose of this study was to describe the morphovolumetric changes of the AAA sac during follow-up after elective EVAR and to analyze sac shrinkage-related variables. METHODS This is a single-center, retrospective, observational cohort study from a tertiary referral university hospital. All patients treated with EVAR between January 2013 and December 2018 were identified. Inclusion criteria were elective EVAR for AAA, preoperative computed tomography angiography within 6 months before EVAR and at least one postoperative computed tomography angiography during the follow-up, using a standardized protocol. Aneurysm sac shrinkage was defined as diameter decrease of 1 cm or more, volume shrinkage threshold was identified by a 16% decrease compared with the preoperative value. Primary outcomes were early (≤30 days) and late survival, and freedom from aneurysm-related mortality (ARM), and aortic reintervention. RESULTS There were 149 of the 325 patients (45.8%) who met the inclusion criteria: 133 (89.3%) were male and 16 (10.7%) female. The mean age was 74 ± 7 years (range, 55-87 years); the median AAA diameter was 56 mm (interquartile range, 50.0-61.2 mm) and the median volume was 138.8 cm3 (range, 99.0-178.3 cm3). Primary technical success was achieved in 145 patients (97.3%). The in-hospital mortality rate was 1.3%. The median follow-up was 42 months (interquartile range, 22.5-58.0 months). Both AAA diameter and volume decreased (P = .001 and P = .035, respectively) compared with preoperative measurements. Diameter shrinkage was adjudicated in 27 patients (18.1%), volume shrinkage was observed in 42 patients (28.2%). A Cox regression analysis demonstrated an association between the AAA diameter shrinkage and the preoperative diameter (P = .002; hazard ratio, 1.03; 95% confidence interval [CI], 1.011-1.052). The presence of a persistent endoleak predicted the absence of volume shrinkage (P = .001; hazard ratio, 7.75; 95% CI, 2.282-26.291). The estimated freedom from ARM was 97.5 ± 1.0% (95% CI, 93-99) at 12 months, and 96 ± 2% (95% CI, 90-98) at both 36 and 60 months. Aortic reintervention during the follow-up period was necessary in 7 patients (4.7%). ARM was only observed in the group characterized by the concomitant absence of diameter and volume shrinkage. CONCLUSIONS Volumetric analysis showed to have higher sensitivity than the simple two-dimensional measurement of the diameter to study AAA sac changes after EVAR. Although no predictor was found to be associated with AAA volume shrinkage, ARM occurred only in the group of AAAs with the absence of volume shrinkage.
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Affiliation(s)
- Marco Franchin
- Department of Medicine and Surgery, Vascular Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Maddalena Serafini
- Department of Medicine and Surgery, Vascular Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Marco Tadiello
- Department of Medicine and Surgery, Vascular Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Federico Fontana
- Interventional Radiology, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Nicola Rivolta
- Department of Medicine and Surgery, Vascular Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Massimo Venturini
- Interventional Radiology, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Marco Curti
- Interventional Radiology, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, Tex
| | - Walter Dorigo
- Department of Clinical and Experimental Medicine, Vascular Surgery, University of Florence School of Medicine, Careggi University Teaching Hospital, Florence, Italy
| | - Filippo Piacentino
- Interventional Radiology, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Vascular Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Vascular Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy.
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Ding N, Hao Y, Wang Z, Xuan X, Kong L, Xue H, Jin Z. CT texture analysis predicts abdominal aortic aneurysm post-endovascular aortic aneurysm repair progression. Sci Rep 2020; 10:12268. [PMID: 32703988 PMCID: PMC7378225 DOI: 10.1038/s41598-020-69226-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/06/2020] [Indexed: 01/21/2023] Open
Abstract
The aim of this study is to investigate the role of early postoperative CT texture analysis in aneurysm progression. Ninety-nine patients who had undergone post-endovascular aneurysm repair (EVAR) infra-renal abdominal aortic aneurysm CT serial scans were enrolled from July 2014 to December 2019. The clinical and traditional imaging features were obtained. Aneurysm texture analysis was performed using three methods—the grey-level co-occurrence matrix (GLCM), the grey-level run length matrix (GLRLM), and the grey-level difference method (GLDM). A multilayer perceptron neural network was applied as a classifier, and receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) analysis were employed to illustrate the classification performance. No difference was found in the morphological and clinical features between the expansion (+) and (−) groups. GLCM yielded the best performance with an accuracy of 85.17% and an AUC of 0.90, followed by GLRLM with an accuracy of 87.23% and an AUC of 0.8615, and GLDM with an accuracy of 86.09% and an AUC of 0.8313. All three texture analyses showed superior predictive ability over clinical risk factors (accuracy: 69.41%; AUC: 0.6649), conventional imaging features (accuracy: 69.02%; AUC: 0.6747), and combined (accuracy: 75.29%; AUC: 0.7249). Early post-EVAR arterial phase-derived aneurysm texture analysis is a better predictor of later aneurysm expansion than clinical factors and traditional imaging evaluation combined.
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Affiliation(s)
- Ning Ding
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist, Beijing, 100730, People's Republic of China
| | - Yunxiu Hao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist, Beijing, 100730, People's Republic of China
| | - Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist, Beijing, 100730, People's Republic of China.
| | - Xiao Xuan
- Neusoft Medical Systems Co. Ltd, Beijing, People's Republic of China
| | - Lingyan Kong
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist, Beijing, 100730, People's Republic of China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist, Beijing, 100730, People's Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist, Beijing, 100730, People's Republic of China.
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Ichihashi S, Takahara M, Fujimura N, Nagatomi S, Iwakoshi S, Bolstad F, Kichikawa K. Multicentre randomised controlled trial to evaluate the efficacy of pre-emptive inferior mesenteric artery embolisation during endovascular aortic aneurysm repair on aneurysm sac change: protocol of Clarify IMA study. BMJ Open 2020; 10:e031758. [PMID: 32066599 PMCID: PMC7044938 DOI: 10.1136/bmjopen-2019-031758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Type II endoleak (EL) is frequently seen after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) and is often considered responsible for aneurysm sac enlargement if it persists. In order to reduce type II EL and consequent sac enlargement, pre-emptive embolisation of the inferior mesenteric artery (IMA), which is a main source for persistent type II EL, has been introduced in many vascular centres. At present, there is a lack of robust evidence to support the efficacy of pre-emptive embolisation of IMA on reduction of persistent type II EL with subsequent sac shrinkage. METHOD AND ANALYSIS This multicentre, randomised controlled trial will recruit 200 patients who have fusiform AAA ≥50 mm/rapidly enlarging fusiform AAA, with patent IMA, and randomly allocate them either to a pre-emptive IMA embolisation group or non-embolisation control group in a ratio of 1:1. The primary endpoint is the difference of aneurysm sac volume change assessed by CT scans between the pre-emptive IMA embolisation group and the control group at 12 months after EVAR. The secondary endpoints are defined as change of aneurysm sac volume in both groups at 6 and 24 months, freedom from sac enlargement at 12 and 24 months after EVAR, prevalence of type II EL at 1, 6, 12 and 24 months evaluated by contrast-enhanced CT, reintervention rate, aneurysm related mortality, overall survival, perioperative morbidity, volume of contrast media used during EVAR and dosage of radiation. ETHICS AND DISSEMINATION The protocol has been reviewed and approved by the ethics committee of Nara Medical University (No. 2113). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry home page. TRIAL REGISTRATION NUMBER UMIN000035502.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University, Suita, Osaka, Japan
| | - Naoki Fujimura
- Vascular Surgery, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
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Kalender G, Lisy M, Stock UA, Endisch A, Kornberger A. Long-term radiation exposure in patients undergoing EVAR: Reflecting clinical day-to-day practice to assess realistic radiation burden. Clin Hemorheol Microcirc 2019; 71:451-461. [PMID: 30248048 DOI: 10.3233/ch-170344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular repair of aortic aneurysms (EVAR) has become an established treatment option currently applied in an increasing numbers of patients with aortic aneurysms. Advantages include reduced surgical trauma, procedural time, intensive care unit and hospital lengths of stay, blood loss as well as morbidity and mortality.The optimal imaging modalities in EVAR follow-up as well as the appropriate intervals between these follow-ups remain subject of controversial discussion. Objective of this study was the evaluation of the realistic radiation exposure and risk estimate postop EVAR treatment.Of the follow-ups required according to the surveillance schedule during the first year post-EVAR, only 68.3% were actually implemented. Of those required from the second year onwards, an average of 70% was actually performed. During the observation period, each patient underwent a mean of 4.3 CTAs. The median ED calculated from all CTAs was 24. 5 mSv. The minimum and maximum cumulative EDs for the entire observation period were 55 mSv and 310 mSv, respectively.
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Affiliation(s)
- G Kalender
- Department of Vascular and Endovascular Surgery, DRK Hospital Berlin Köpenick, Berlin, Germany
| | - M Lisy
- Department of Vascular and Endovascular Surgery, Krankenhaus Nordwest Frankfurt, Germany
| | - U A Stock
- Department of Cardiac and Transplant Surgery, Royal Brompton and Harefield NHS Trust, Harefield, UK
| | - A Endisch
- Department of Vascular and Endovascular Surgery, Asklepios Hospital Bad Tölz, Germany
| | - A Kornberger
- Department of Vascular, Thoracic and Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Germany
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Quan C, Oh YK, Park SC, Won YS, Yun SS, Suh YJ, Kim JY. Efficacy of volumetric analysis of aorta as surveillance tool after EVAR. Asian J Surg 2019; 42:746-754. [DOI: 10.1016/j.asjsur.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/05/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
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Riahi A, Kauffmann C, Therasse E, Morin-Roy F, Elkouri S, Gilbert P, Giroux MF, Perreault P, Bouchard L, Oliva VL, Soulez G. Clinical Validation of a Semi-Automated Software for Maximal Diameter Measurements for Endovascular Repair Follow-up. J Vasc Interv Radiol 2019; 30:523-530. [PMID: 30910174 DOI: 10.1016/j.jvir.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/25/2018] [Accepted: 11/04/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare automated measurements of maximal diameter (Dmax) of abdominal aortic aneurysm (AAA) orthogonal to luminal or outer wall envelope centerline for endovascular repair (EVAR) follow-up. MATERIAL AND METHODS Eighty-three consecutive patients with AAA treated by EVAR who had at least 1 computed tomography (CT) scan before and 2 CT scans after EVAR with at least 5 months' interval were included. Three-dimensional reconstruction of the AAA was achieved with dedicated segmentation software. Performances of automated calculation algorithms of Dmax perpendicular to lumen or outer wall envelope centerlines were then compared to manual measurement of Dmax on double-oblique multiplanar reconstruction (gold standard). Accuracy of automated Dmax measurements at baseline, follow-up, and progression over time was evaluated by calculation of mean error, Bland-Altman plot, and regression models. RESULTS Disagreement in Dmax measurements between outer wall envelope algorithm and manual method was insignificant (mean error: baseline, -0.07 ± 1.66 mm, P = .7; first follow-up, 0.24 ± 1.69 mm, P = .2; last follow-up, -0.41 ± 2.74 mm, P = .17); whereas significant discrepancies were found between the luminal algorithm and the manual method (mean error: baseline, -1.24 ± 2.01 mm, P < .01; first follow-up, -1.49 ± 3.30 mm, P < .01; last follow-up, -1.78 ± 3.60 mm, P < .01). Dmax progression results were more accurate with AAA outer wall envelope algorithm compared to luminal method (P = .2). CONCLUSIONS AAA outer wall envelope segmentation is recommended to enable automated calculation of Dmax perpendicular to its centerline during EVAR follow-up.
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Affiliation(s)
- Amine Riahi
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4
| | - Claude Kauffmann
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Laboratoire Central du Traitement de l'Image, Research Imaging Platform, University of Montreal Hospital Research Center, Montreal, Canada
| | - Eric Therasse
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Florence Morin-Roy
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4
| | - Stephane Elkouri
- Department of Surgery, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Patrick Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Marie-France Giroux
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Pierre Perreault
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Louis Bouchard
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Vincent L Oliva
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Gilles Soulez
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Institute of Biomedical Engineering, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Laboratoire Central du Traitement de l'Image, Research Imaging Platform, University of Montreal Hospital Research Center, Montreal, Canada; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada.
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12
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Planz VB, Lubner MG, Pickhardt PJ. Volumetric analysis at abdominal CT: oncologic and non-oncologic applications. Br J Radiol 2018; 92:20180631. [PMID: 30457881 DOI: 10.1259/bjr.20180631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Volumetric analysis is an objective three-dimensional assessment of a lesion or organ that may more accurately depict the burden of complex objects compared to traditional linear size measurement. Small changes in linear size are amplified by corresponding changes in volume, which could have significant clinical implications. Though early methods of calculating volumes were time-consuming and laborious, multiple software platforms are now available with varying degrees of user-software interaction ranging from manual to fully automated. For the assessment of primary malignancy and metastatic disease, volumetric measurements have shown utility in the evaluation of disease burden prior to and following therapy in a variety of cancers. Additionally, volume can be useful in treatment planning prior to resection or locoregional therapies, particularly for hepatic tumours. The utility of CT volumetry in a wide spectrum of non-oncologic pathology has also been described. While clear advantages exist in certain applications, some data have shown that volume is not always the superior method of size assessment and the associated labor intensity may not be worthwhile. Further, lack of uniformity among software platforms is a challenge to widespread implementation. This review will discuss CT volumetry and its potential oncologic and non-oncologic applications in abdominal imaging, as well as advantages and limitations to this quantitative technique.
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Affiliation(s)
| | | | - Perry J Pickhardt
- 1 Department of Radiology, The University of Wisconsin School of Medicine & Public Health , Madison, WI , USA
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13
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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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14
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Boos J, Brook OR, Fang J, Temin N, Brook A, Raptopoulos V. What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair? Radiology 2017; 285:1032-1041. [DOI: 10.1148/radiol.2017161424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Johannes Boos
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Olga R. Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Jieming Fang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Nathaniel Temin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Vasillios Raptopoulos
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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Identification of Factors Influencing Cumulative Long-Term Radiation Exposure in Patients Undergoing EVAR. Int J Vasc Med 2017; 2017:9763075. [PMID: 29250445 PMCID: PMC5700475 DOI: 10.1155/2017/9763075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/24/2017] [Accepted: 10/03/2017] [Indexed: 02/01/2023] Open
Abstract
Patients who undergo endovascular repair of aortic aneurysms (EVAR) require life-long surveillance because complications including, in particular, endoleaks, aneurysm rupture, and graft dislocation are diagnosed in a certain share of the patient population and may occur at any time after the original procedure. Radiation exposure in patients undergoing EVAR and post-EVAR surveillance has been investigated by previous authors. Arriving at realistic exposure data is essential because radiation doses resulting from CT were shown to be not irrelevant. Efforts directed at identification of factors impacting the level of radiation exposure in both the course of the EVAR procedure and post-EVAR endovascular interventions and CTAs are warranted as potentially modifiable factors may offer opportunities to reduce the radiation. In the light of the risks found to be associated with radiation exposure and considering the findings above, those involved in EVAR and post-EVAR surveillance should aim at optimal dose management.
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Bonci G, Steigner ML, Hanley M, Braun AR, Desjardins B, Gaba RC, Gage KL, Matsumura JS, Roselli EE, Sella DM, Strax R, Verma N, Weiss CR, Dill KE. ACR Appropriateness Criteria® Thoracic Aorta Interventional Planning and Follow-Up. J Am Coll Radiol 2017; 14:S570-S583. [DOI: 10.1016/j.jacr.2017.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
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17
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Diard A, Becker F, Pichot O. [Quality standards for duplex ultrasonographic assessment (duplex us) of abdominal aortic stent grafts]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:170-184. [PMID: 28705406 DOI: 10.1016/j.jdmv.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
The quality standards of the French Society of Vascular Medicine for the ultrasound assessment of lower limb arteries in vascular medicine practice are based on the principle that these examinations have to meet two requirements: technical know-how (knowledge of devices and methodologies); medical know-how (level of examination matching the indication and purpose of the examination, interpretation and critical analysis of results). OBJECTIVES OF THE QUALITY STANDARDS To describe an optimal level of examination adjusted to the indication or clinical hypothesis; to establish harmonious practices, methodologies, terminologies, results description and report; to provide good practice reference points and to promote a high quality process. THEMES OF THE QUALITY STANDARDS The three levels of examination, indications and objectives for each level; the reference standard examination (level 2) and its variants according to indications; the minimal content of the exam report, the medical conclusion letter to the corresponding physician (synthesis, conclusion and management suggestions); commented glossary (anatomy, hemodynamics, signs and symptoms); technical basis; device settings. Here, we discuss duplex ultrasound for the supervision of the aortic stent grafts.
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Affiliation(s)
- A Diard
- 25, route de Créon, 33550 Langoiran, France.
| | - F Becker
- Service d'angiologie et d'hémostase, hôpitaux universitaires de Genève, hôpital Cantonal, 1211 Genève, France
| | - O Pichot
- 7, rue Lesdiguières, 38000 Grenoble, France
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Dynamic Geometric Analysis of the Renal Arteries and Aorta following Complex Endovascular Aneurysm Repair. Ann Vasc Surg 2017; 43:85-95. [PMID: 28390918 DOI: 10.1016/j.avsg.2016.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Aneurysm regression and target vessel patency during early and mid-term follow-up may be related to the effect of stent-graft configuration on the anatomy. We quantified geometry and remodeling of the renal arteries and aneurysm following fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). METHODS Twenty-nine patients (mean age, 76.8 ± 7.8 years) treated with F- or Sn-EVAR underwent computed tomography angiography at preop, postop, and follow-up. Three-dimensional geometric models of the aorta and renal arteries were constructed. Renal branch angle was defined relative to the plane orthogonal to the aorta. End-stent angle was defined as the angulation between the stent and native distal artery. Aortic volumes were computed for the whole aorta, lumen, and their difference (excluded lumen). Renal patency, reintervention, early mortality, postoperative renal impairment, and endoleak were reviewed. RESULTS From preop to postop, F-renal branches angled upward, Sn-renal branches angled downward (P < 0.05), and Sn-renals exhibited increased end-stent angulation (12 ± 15°, P < 0.05). From postop to follow-up, branch angles did not change for either F- or Sn-renals, whereas F-renals exhibited increased end-stent angulation (5 ± 10°, P < 0.05). From preop to postop, whole aortic and excluded lumen volumes increased by 5 ± 14% and 74 ± 81%, whereas lumen volume decreased (39 ± 27%, P < 0.05). From postop to follow-up, whole aortic and excluded lumen volumes decreased similarly (P < 0.05), leaving the lumen volume unchanged. At median follow-up of 764 days (range, 7-1,653), primary renal stent patency was 94.1% and renal impairment occurred in 2 patients (6.7%). CONCLUSIONS Although F- and Sn-EVAR resulted in significant, and opposite, changes to renal branch angle, only Sn-EVAR resulted in significant end-stent angulation increase. Longitudinal geometric analysis suggests that these anatomic alterations are primarily generated early as a consequence of the procedure itself and, although persistent, they show no evidence of continued significant change during the subsequent postoperative follow-up period.
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Meinel FG, Haack M, Weidenhagen R, Hellbach K, Rottenkolber M, Armbruster M, Jerkku T, Thierfelder KM, Plum JL, Koeppel TA, Rubin GD, Sommer WH. Effect of endoleaks on changes in aortoiliac volume after endovascular repair for abdominal aortic aneurysm. Clin Hemorheol Microcirc 2016; 64:135-147. [DOI: 10.3233/ch-162052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Felix G. Meinel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Mareike Haack
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Rolf Weidenhagen
- Department of Vascular and Endovascular Surgery, Munich Municipal Hospital Group, Klinikum Neuperlach, Munich, Germany
| | - Katharina Hellbach
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry and Epidemiology, Munich, Germany
| | - Marco Armbruster
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Thomas Jerkku
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Kolja M. Thierfelder
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Jessica L.V. Plum
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Thomas A. Koeppel
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Wieland H. Sommer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
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20
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Three-dimensional Ultrasound in the Management of Abdominal Aortic Aneurysms: A Topical Review. Eur J Vasc Endovasc Surg 2016; 52:466-474. [DOI: 10.1016/j.ejvs.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
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21
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Imaging-Based Predictors of Persistent Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair. AJR Am J Roentgenol 2016; 206:1335-40. [DOI: 10.2214/ajr.15.15254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wanhainen A, Mani K, Golledge J. Surrogate Markers of Abdominal Aortic Aneurysm Progression. Arterioscler Thromb Vasc Biol 2016; 36:236-44. [DOI: 10.1161/atvbaha.115.306538] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/14/2015] [Indexed: 12/25/2022]
Abstract
The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Standardized reporting of reproducible methods of measuring AAA diameter is essential. Newer imaging assessments, such as volume measurements, biomechanical analyses, and functional and molecular imaging, as well as circulating biomarkers, have potential to add important information about AAA progression. Currently, however, there is insufficient evidence to recommend their routine use in clinical practice.
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Affiliation(s)
- Anders Wanhainen
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| | - Kevin Mani
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| | - Jonathan Golledge
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
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Bryce Y, Rogoff P, Romanelli D, Reichle R. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications. Radiographics 2016; 35:593-615. [PMID: 25763741 DOI: 10.1148/rg.352140045] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR.
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Affiliation(s)
- Yolanda Bryce
- From the Department of Radiology, Mount Auburn Hospital, 330 Mount Auburn St, Cambridge, MA 02138
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Cassagnes L, Pérignon R, Amokrane F, Petermann A, Bécaud T, Saint-Lebes B, Chabrot P, Rousseau H, Boyer L. Aortic stent-grafts: Endoleak surveillance. Diagn Interv Imaging 2016; 97:19-27. [DOI: 10.1016/j.diii.2014.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
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Nomura Y, Sugimoto K, Gotake Y, Yamanaka K, Sakamoto T, Muradi A, Okada T, Yamaguchi M, Okita Y. Comparison of Volumetric and Diametric Analysis in Endovascular Repair of Descending Thoracic Aortic Aneurysm. Eur J Vasc Endovasc Surg 2015; 50:53-9. [DOI: 10.1016/j.ejvs.2015.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
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Brambilla M, Cerini P, Lizio D, Vigna L, Carriero A, Fossaceca R. Cumulative radiation dose and radiation risk from medical imaging in patients subjected to endovascular aortic aneurysm repair. Radiol Med 2015; 120:563-70. [PMID: 25572540 DOI: 10.1007/s11547-014-0485-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/27/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE This study was undertaken to quantify the cumulative effective dose (CED) of radiation and the dose to relevant organs in endovascular aortic repair (EVAR) patients, to assess radiation risks and to evaluate the clinical usefulness of multi-detector computed tomography (MDCT) follow-up. MATERIALS AND METHODS The radiation exposures were obtained from 71 consecutive EVAR patients with a follow-up duration ≥1 year. Dose calculations were performed on an individual basis and expressed as effective doses and organ doses. Radiation risk was expressed as risk of exposure-induced death (%), using the biological effects of ionising radiation model. Two radiologists independently assessed the images for abdominal aortic aneurysm expansion without endoleaks, thrombotic occlusion, endoleaks and device migration. They first reviewed arterial imaging alone and subsequently added non-contrast and delayed phases to determine the overall performance. RESULTS The median total CED and annual CED were 224 and 104 mSv per patient-year. The median cumulative organ doses were 191, 205, 230, 269 and 271 mSv for lung, bone marrow, liver, colon and stomach, respectively. The average risk of exposure-induced death was 0.8 % (i.e., odds 1 in 130). All the findings related to EVAR outcome and leading to a change in patient management were visible during the arterial phase of the MDCT angiography. Omission of the unenhanced scan and the venous phase of the MDCT angiography would have led to a significant reduction of about 60 % of the associated MDCT radiation exposure in a single patient. CONCLUSIONS EVAR patients received high radiation doses and the excess cancer risk attributable to radiation exposure is not negligible. The unenhanced scan and the venous phase of the MDCT angiography could have been omitted without compromising the utility of the examination and with a significant reduction of doses and associated risks.
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Affiliation(s)
- Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy,
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Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications. AJR Am J Roentgenol 2014; 203:W358-72. [PMID: 25247965 DOI: 10.2214/ajr.13.11736] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure. CONCLUSION A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.
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Rubin GD, Leipsic J, Joseph Schoepf U, Fleischmann D, Napel S. CT angiography after 20 years: a transformation in cardiovascular disease characterization continues to advance. Radiology 2014; 271:633-52. [PMID: 24848958 DOI: 10.1148/radiol.14132232] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovations in CT and image processing, over the next 5-15 years, CT angiography toppled conventional angiography, the undisputed diagnostic reference standard for vascular disease for the prior 70 years, as the preferred modality for the diagnosis and characterization of most cardiovascular abnormalities. This review recounts the evolution of CT angiography from its development and early challenges to a maturing modality that has provided unique insights into cardiovascular disease characterization and management. Selected clinical challenges, which include acute aortic syndromes, peripheral vascular disease, aortic stent-graft and transcatheter aortic valve assessment, and coronary artery disease, are presented as contrasting examples of how CT angiography is changing our approach to cardiovascular disease diagnosis and management. Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiation dose reduction through iterative reconstruction are explored with consideration toward the continued refinement and advancement of CT angiography.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute, 2400 Pratt St, Box 17969, Durham, NC 27715 (G.D.R.); Department of Medical Imaging and Division of Cardiology, University of British Columbia, Vancouver, BC, Canada (J.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.F., S.N.)
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Tse DML, Tapping CR, Patel R, Morgan R, Bratby MJ, Anthony S, Uberoi R. Surveillance After Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2014; 37:875-88. [DOI: 10.1007/s00270-014-0916-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 04/03/2014] [Indexed: 02/05/2023]
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30
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Naidu SG, Kriegshauser JS, Paden RG, He M, Wu Q, Hara AK. Ultra-low-dose computed tomographic angiography with model-based iterative reconstruction compared with standard-dose imaging after endovascular aneurysm repair: a prospective pilot study. ACTA ACUST UNITED AC 2014; 39:1297-303. [PMID: 24859850 DOI: 10.1007/s00261-014-0166-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sailen G Naidu
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, 85054, Phoenix, AZ, USA,
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31
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Morin-Roy F, Kauffmann C, Tang A, Hadjadj S, Thomas O, Piché N, Elkouri S, Yang DY, Therasse É, Soulez G. Impact of contrast injection and stent-graft implantation on reproducibility of volume measurements in semiautomated segmentation of abdominal aortic aneurysm on computed tomography. Eur Radiol 2014; 24:1594-601. [PMID: 24801978 DOI: 10.1007/s00330-014-3175-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/19/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the impact of contrast injection and stent-graft implantation on feasibility, accuracy, and reproducibility of abdominal aortic aneurysm (AAA) volume and maximal diameter (D-max) measurements using segmentation software. MATERIALS AND METHODS CT images of 80 subjects presenting AAA were divided into four equal groups: with or without contrast enhancement, and with or without stent-graft implantation. Semiautomated software was used to segment the aortic wall, once by an expert and twice by three readers. Volume and D-max reproducibility was estimated by intraclass correlation coefficients (ICC), and accuracy was estimated between the expert and the readers by mean relative errors. RESULTS All segmentations were technically successful. The mean AAA volume was 167.0 ± 82.8 mL and the mean D-max 55.0 ± 10.6 mm. Inter- and intraobserver ICCs for volume and D-max measurements were greater than 0.99. Mean relative errors between readers varied between -1.8 ± 4.6 and 0.0 ± 3.6 mL. Mean relative errors in volume and D-max measurements between readers showed no significant difference between the four groups (P ≥ 0.2). CONCLUSION The feasibility, accuracy, and reproducibility of AAA volume and D-max measurements using segmentation software were not affected by the absence of contrast injection or the presence of stent-graft. KEY POINTS • AAA volumetry by semiautomated segmentation is accurate on CT following endovascular repair. • AAA volumetry by semiautomated segmentation is accurate on unenhanced CT. • Standardization of the segmentation technique maximizes the reproducibility of volume measurements.
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Affiliation(s)
- Florence Morin-Roy
- Department of Radiology, Centre Hospitalier Universitaire de Montréal (CHUM), Hôpital Notre-Dame, 1560 Sherbrooke Est, Montréal, Québec, Canada, H2L 4M1,
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Morphologic evaluation of ruptured and symptomatic abdominal aortic aneurysm by three-dimensional modeling. J Vasc Surg 2014; 59:894-902.e3. [PMID: 24439318 DOI: 10.1016/j.jvs.2013.10.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify geometric indices of abdominal aortic aneurysms (AAAs) on computed tomography that are associated with higher risk of rupture. METHODS This retrospective case-control, institutional review board-approved study involved 63 cases with ruptured or symptomatic AAA and 94 controls with asymptomatic AAA. Three-dimensional models were generated from computed tomography segmentation and used for the calculation of 27 geometric indices. On the basis of the results of univariate analysis and multivariable sequential logistic regression analyses with a forward stepwise model selection based on likelihood ratios, a traditional model based on gender and maximal diameter (Dmax) was compared with a model that also incorporated geometric indices while adjusting for gender and Dmax. Receiver operating characteristic (ROC) curves were calculated for these two models to evaluate their classification accuracy. RESULTS Univariate analysis revealed that gender (P = .024), Dmax (P = .001), and 14 other geometric indices were associated with AAA rupture at P < .05. In the multivariable analysis, adjusting for gender and Dmax, the AAA with a higher bulge location (P = .020) and lower mean averaged area (P = .005) were associated with AAA rupture. With these two geometric indices, the area under the ROC curve showed an improvement from 0.67 (95% confidence interval, 0.58-0.77) to 0.75 (95% confidence interval, 0.67-0.83; P < .001). Our predictive model showed comparable sensitivity (64% vs 60%) and specificity (79% vs 77%) with current treatment criteria based on gender and diameter at the point optimizing the Youden index (sensitivity + specificity - 1) on the ROC curve. CONCLUSIONS Two geometric indices derived from AAA three-dimensional modeling were independently associated with AAA rupture. The addition of these indices in a predictive model based on current treatment criteria modestly improved the accuracy to detect aneurysm rupture.
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Demehri S, Signorelli J, Kumamaru KK, Wake N, George E, Hanley M, Steigner ML, Steinger ML, Gravereaux EC, Rybicki FJ. Volumetric quantification of type II endoleaks: an indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair. Radiology 2013; 271:282-90. [PMID: 24475801 DOI: 10.1148/radiol.13130157] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta. MATERIALS AND METHODS The institutional review board approved and waived the need to obtain patient consent for this HIPAA-compliant retrospective study. In 72 patients who underwent EVAR, 160 computed tomographic (CT) angiography studies revealed type II endoleaks. Corresponding to these 160 CT angiography studies, 113 CT follow-up studies (in 52 patients) were available and were included in the analysis. ECV measurements were obtained by two observers in consensus by using arterial enhanced phase (ECVAEP) and 70-second delayed enhanced phase (ECVDEP) CT images. The ECVDEP was also normalized as the ECV/ASV ratio. Maximum (ECDM) and transverse (ECDT) ECDs were determined from delayed enhanced phase images. The outcome was determined as interval increase (>2%) in ASV versus stable or decreasing (≤2%) ASV. Receiver operating characteristic (ROC) analysis was used to compare the accuracy of type II ECV and ECD measurements in indicating interval increase in ASV. RESULTS In 56 (49.5%) of 113 CT studies in type II endoleaks, there was an interval increase in ASV. The accuracies of ECVDEP (area under the ROC curve [AUC], 0.85) and normalized ECVDEP (AUC, 0.86) were superior to the accuracies of ECDM (AUC, 0.73), ECDT (AUC, 0.73), and ECVAEP (AUC, 0.66). At ROC curve analysis, the sensitivity, specificity, and positive and negative predictive values for type II endoleak cavities with an ECVDEP of less than 0.5 mL for showing no future sac volume enlargement were 33% (19 of 57), 100% (56 of 56), 100% (19 of 19), and 60% (56 of 94), respectively. CONCLUSION With use of the delayed enhanced phase of CT angiography, ECV measurement is an accurate indicator of aneurysm sac enlargement.
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Affiliation(s)
- Shadpour Demehri
- From the Department of Radiology (J.S., K.K.K., N.W., E.G., M.L.S., F.J.R.), Applied Imaging Science Laboratory (S.D., J.S., K.K.K., N.W., E.G., M.L.S., F.J.R.), and Department of Vascular Surgery (E.C.G.), Brigham and Women's Hospital, Boston, Mass
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Bobadilla JL, Suwanabol PA, Reeder SB, Pozniak MA, Bley TA, Tefera G. Clinical implications of non-contrast-enhanced computed tomography for follow-up after endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2013; 27:1042-8. [PMID: 23711975 DOI: 10.1016/j.avsg.2012.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/03/2012] [Accepted: 10/09/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is growing concern over the long-term radiation exposure from serial computed tomographic (CT) scan follow-up after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). Screening for endoleaks with non-contrast-enhanced volumetric CT has been shown to significantly reduce radiation doses. We evaluated the use of NCT as the primary method of follow-up after EVAR of AAAs. METHODS Our institutional post-EVAR CT protocol consisted of contrast-enhanced CT angiography (CTA) 1 month after repair, followed by NCT at 3 or 6 and 12 months, and annually thereafter. At each follow-up scan, immediate 3-dimensional volume analysis was performed. If the volume change was <2%, NCT follow-up was continued. If the volume increased by ≥2% on nonenhanced images, contrast-enhanced CT was performed immediately to identify potential endoleaks. All images were reviewed by an experienced cardiovascular radiologist. End points included identification of endoleak, reintervention, and rupture. RESULTS Over a 7-year period, 126 patients were followed. Serial CTA was performed in 59 patients, while 67 patients were followed with the NCT protocol. The mean follow-up was 2.07 years. There were no differences in age, sex, or initial aneurysm volume or size. There were 35 total endoleaks identified. Twenty of these were early endoleaks (<30 days post-EVAR). The remaining 15 leaks were late in nature (10 in the contrast group and 5 in the noncontrast group; P=0.17). NCT aneurysm sac volume changes prompted contrasted studies in all 5 late leaks. The mean volume change was 11.2 cm3, an average change of 5.88%. These findings were not significantly different than the late leaks found by routine contrast studies (8.9 cm3; 4.98% [P=0.58]). There were no delayed ruptures or emergent reinterventions in the NCT group. CONCLUSIONS Serial NCT appears to be safe and effective as the sole means of follow-up after EVAR for AAAs. AAA volume increases of ≥2% should prompt further contrast-enhanced CT imaging. Changes of <2% can be safely followed with serial NCT. This protocol requires dedicated cardiovascular radiologist involvement, and patients should be retained in the radiology suite until real-time image evaluation can be completed.
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Affiliation(s)
- Joseph Louis Bobadilla
- Department of Surgery, Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Liu PS, Platt JF. CT angiography in the abdomen: a pictorial review and update. ACTA ACUST UNITED AC 2013; 39:196-214. [DOI: 10.1007/s00261-013-0035-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ward TJ, Cohen S, Fischman AM, Kim E, Nowakowski FS, Ellozy SH, Faries PL, Marin ML, Lookstein RA. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol 2013; 24:49-55. [PMID: 23273697 DOI: 10.1016/j.jvir.2012.09.022] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review the effect of preoperative embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) on subsequent endoleaks and aneurysm growth. MATERIALS AND METHODS Between August 2002 and May 2010, 108 patients underwent IMA embolization before EVAR. Coil embolization was performed in all patients in whom the IMA was successfully visualized and accessed during preoperative conventional angiography. In this cohort, the incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and repeat intervention were compared with a group of 158 consecutive patients with a patent IMA on preoperative computed tomography angiography but not on conventional angiography, who therefore did not undergo preoperative embolization. RESULTS The incidence of type II endoleak was significantly higher in patients not treated with embolization (49.4% [78 of 158] vs 34.3% [37 of 108]; P = .015). The incidence of secondary intervention for type II endoleak embolization was also significantly higher in those who did not undergo embolization (7.6% [12 of 158] vs 0.9% [one of 108]; P = .013). At 24 months, an increase in aneurysm sac volume was observed in 47% of patients in the nonembolized cohort (21 of 45), compared with 26% of patients in the embolized cohort (13 of 51; P = .03). No aneurysm ruptures or aneurysm-related deaths were observed in either group. One patient in the embolization group developed mesenteric ischemia and ultimately died. CONCLUSIONS Preoperative embolization of the IMA was associated with reduced incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and secondary intervention.
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Affiliation(s)
- Thomas J Ward
- Department of Interventional Radiology, Mount Sinai Medical Center, New York, NY 10029, USA
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Kitagawa A, Mastracci TM, von Allmen R, Powell JT. The role of diameter versus volume as the best prognostic measurement of abdominal aortic aneurysms. J Vasc Surg 2013; 58:258-65. [DOI: 10.1016/j.jvs.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Endoleak Detection After Endovascular Repair of Thoracic Aortic Aneurysm Using Dual-Source Dual-Energy CT: Suitable Scanning Protocols and Potential Radiation Dose Reduction. AJR Am J Roentgenol 2013; 200:451-60. [DOI: 10.2214/ajr.11.8033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Nagayama H, Sueyoshi E, Sakamoto I, Uetani M. Endovascular abdominal aortic aneurysm repair: surveillance of endoleak using maximum transverse diameter of aorta on non-enhanced CT. Acta Radiol 2012; 53:652-6. [PMID: 22777147 DOI: 10.1258/ar.2012.120018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. PURPOSE To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. MATERIAL AND METHODS CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. RESULTS Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 ± 1.9 vs. -1.1 ± 3.0 mm, P < 0.0001). When the Dmax change ≤ 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change ≤-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. CONCLUSION Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR.
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Affiliation(s)
- Hiroki Nagayama
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Ichiro Sakamoto
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
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Hahne J, Arndt C, Herrmann J, Schönnagel B, Adam G, Habermann C. Follow-up of abdominal aortic aneurysm after endovascular aortic repair: Comparison of volumetric and diametric measurement. Eur J Radiol 2012; 81:1187-91. [DOI: 10.1016/j.ejrad.2011.03.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
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van den Berg JC. Commentary: Type II endoleaks: still the crux of EVAR? J Endovasc Ther 2012; 19:209-12. [PMID: 22545886 DOI: 10.1583/11-3653c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano sede Civico, Lugano, Switzerland.
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Maturen KE, Kaza RK, Liu PS, Quint LE, Khalatbari SH, Platt JF. "Sweet spot" for endoleak detection: optimizing contrast to noise using low keV reconstructions from fast-switch kVp dual-energy CT. J Comput Assist Tomogr 2012; 36:83-7. [PMID: 22261775 PMCID: PMC3265790 DOI: 10.1097/rct.0b013e31824258cb] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess endoleak detection and conspicuity using low-kiloelectron volt (keV) monochromatic reconstructions of single-source (fast-switch kilovolt [peak]) dual-energy data sets. METHODS With approval of the institutional review board, multiphasic dual-energy computed tomographic (CT) scans for aortic endograft surveillance were retrospectively reviewed for 39 patients. Two abdominal radiologists each performed 2 separate reading sessions, at 55-keV and standard 75-keV reconstruction, respectively. The readers tabulated endoleak presence, conspicuity on 1-to-5 scale, and type overall and in arterial and venous phases. Originally, dictated reports in medical records were used as criterion standard. RESULTS Original dictations identified 19 endoleaks (9 abdominal and 10 thoracic), 13 of which were type II. The blinded readers (R1 and R2) exhibited good to very good intraobserver and interobserver agreement. Endoleak detection was higher at 55 keV than at 75 keV (sensitivity, 100% (95% confidence interval [CI], 82.4%-100.0%) and 84.2% (95% CI, 60.4-96.6%) at 55 keV vs 79% (95% CI, 54.4-94.0%) and 68.4% (95% CI, 43.5%-87.4%) at 75 keV in venous phase). Further, endoleak conspicuity ratings (where original dictation showed positive leak) were higher at 55 keV than at 75 keV, which was a significant difference for R2 in the overall ratings (P = 0.03) and for both readers in the venous phase ratings (R1, P = 0.01; R2, P = 0.004). There was no difference in endoleak type characterization between the kiloelectron volt levels. CONCLUSION Sensitivity for endoleak detection and overall endoleak conspicuity ratings were both higher at 55 keV than 75 keV, favoring the inclusion of a lower-energy monochromatic reconstruction for endoleak surveillance protocols with dual-energy computed tomography.
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Affiliation(s)
- Katherine E Maturen
- University of Michigan Hospitals, Department of Radiology UH B1D530H, 1500 E Medical Center Drive, Ann Arbor MI 48109-5030, Phone (734) 232-6044, Fax (734) 615-1276,
| | - Ravi K Kaza
- University of Michigan Hospitals, Department of Radiology TC B1132, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030,
| | - Peter S Liu
- University of Michigan Hospitals, Department of Radiology UH B2A209, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030,
| | - Leslie E Quint
- University of Michigan Hospitals, Department of Radiology UH B1D530F, 1500 E Medical Center Drive, Ann Arbor MI 48109-5030,
| | - Shokoufeh H Khalatbari
- Michigan Inst. of Clinical and Health Research, 24 Frank Lloyd Wright, Lobby M 5738, Ann Arbor, MI 48109,
| | - Joel F Platt
- University of Michigan Hospitals, Department of Radiology UH B1D502, 1500 E Medical Center Drive, Ann Arbor MI 48109-5030,
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Management of peripheral arterial disease: Role of computed tomography angiography and magnetic resonance angiography. Presse Med 2011; 40:e437-52. [DOI: 10.1016/j.lpm.2010.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022] Open
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Dugas A, Therasse É, Kauffmann C, Tang A, Elkouri S, Nozza A, Giroux MF, Oliva VL, Soulez G. Reproducibility of Abdominal Aortic Aneurysm Diameter Measurement and Growth Evaluation on Axial and Multiplanar Computed Tomography Reformations. Cardiovasc Intervent Radiol 2011; 35:779-87. [DOI: 10.1007/s00270-011-0259-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
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Canì A, Cotta E, Recaldini C, Lumia D, Fontana F, Carrafiello G, Colli V, Fugazzola C. Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment. Radiol Med 2011; 117:72-84. [PMID: 21643642 DOI: 10.1007/s11547-011-0687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/30/2010] [Indexed: 11/29/2022]
Affiliation(s)
- A Canì
- Ospedale di Circolo e Fondazione Macchi, Scuola di Specializzazione in Radiodiagnostica, Università degli Studi dell'Insubria, Viale Borri 57, 21100, Varese, Italy.
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Kauffmann C, Tang A, Therasse E, Giroux MF, Elkouri S, Melanson P, Melanson B, Oliva VL, Soulez G. Measurements and detection of abdominal aortic aneurysm growth: Accuracy and reproducibility of a segmentation software. Eur J Radiol 2011; 81:1688-94. [PMID: 21601403 DOI: 10.1016/j.ejrad.2011.04.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 04/07/2011] [Accepted: 04/13/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE To validate the reproducibility and accuracy of a software dedicated to measure abdominal aortic aneurysm (AAA) diameter, volume and growth over time. MATERIALS AND METHODS A software enabling AAA segmentation, diameter and volume measurement on computed tomography angiography (CTA) was tested. Validation was conducted in 28 patients with an AAA having 2 consecutive CTA examinations. The segmentation was performed twice by a senior radiologist and once by 3 medical students on all 56 CTAs. Intra and inter-observer reproducibility of D-max and volumes values were calculated by intraclass correlation coefficient (ICC). Systematic errors were evaluated by Bland-Altman analysis. Differences in D-max and volume growth were compared with paired Student's t-tests. RESULTS Mean D-max and volume were 49.6±6.2mm and 117.2±36.2ml for baseline and 53.6±7.9mm and 139.6±56.3ml for follow-up studies. Volume growth (17.3%) was higher than D-max progression (8.0%) between baseline and follow-up examinations (p<.0001). For the senior radiologist, intra-observer ICC of D-max and volume measurements were respectively estimated at 0.997 (≥0.991) and 1.000 (≥0.999). Overall inter-observer ICC of D-max and volume measurements were respectively estimated at 0.995 (0.990-0.997) and 0.999 (>0.999). Bland-Altman analysis showed excellent inter-reader agreement with a repeatability coefficient <3mm for D-max, <7% for relative D-max growth, <6ml for volume and <6% for relative volume growth. CONCLUSION Software AAA volume measurements were more sensitive than AAA D-max to detect AAA growth while providing an equivalent and high reproducibility.
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Affiliation(s)
- Claude Kauffmann
- Department of Radiology, Centre Hospitalier Universitaire de Montréal and CHUM Research Center, University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montréal, Québec, Canada.
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Non-contrast Computed Tomography is Comparable to Contrast-enhanced Computed Tomography for Aortic Volume Analysis after Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 41:460-6. [DOI: 10.1016/j.ejvs.2010.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/27/2010] [Indexed: 11/22/2022]
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Hong H, Yang Y, Liu B, Cai W. Imaging of Abdominal Aortic Aneurysm: the present and the future. Curr Vasc Pharmacol 2011; 8:808-19. [PMID: 20180767 DOI: 10.2174/157016110793563898] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 01/07/2010] [Indexed: 01/02/2023]
Abstract
Abdominal Aortic Aneurysm (AAA) is a common, progressive, and potentially lethal vascular disease. A major obstacle in AAA research, as well as patient care, is the lack of technology that enables non-invasive acquisition of molecular/cellular information in the developing AAA. In this review we will briefly summarize the current techniques (e.g. ultrasound, computed tomography, and magnetic resonance imaging) for anatomical imaging of AAA. We also discuss the various functional imaging techniques that have been explored for AAA imaging. In many cases, these anatomical and functional imaging techniques are not sufficient for providing surgeons/clinicians enough information about each individual AAA (e.g. rupture risk) to optimize patient management. Recently, molecular imaging techniques (e.g. optical and radionuclide-based) have been employed to visualize the molecular alterations associated with AAA, which are discussed in this review. Lastly, we try to provide a glance into the future and point out the challenges for AAA imaging. We believe that the future of AAA imaging lies in the combination of anatomical and molecular imaging techniques, which are largely complementary rather than competitive. Ultimately, with the right molecular imaging probe, clinicians will be able to monitor AAA growth and evaluate the risk of rupture accurately, so that the life-saving surgery can be provided to the right patients at the right time. Equally important, the right imaging probe will also allow scientists/clinicians to acquire critical data during AAA development and to more accurately evaluate the efficacy of potential treatments.
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Affiliation(s)
- Hao Hong
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI 53705-2275, USA
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