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Hallett RL, Ullery BW, Fleischmann D. Abdominal aortic aneurysms: pre- and post-procedural imaging. Abdom Radiol (NY) 2018; 43:1044-1066. [PMID: 29460048 DOI: 10.1007/s00261-018-1520-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a relatively common, potentially life-threatening disorder. Rupture of AAA is potentially catastrophic with high mortality. Intervention for AAA is indicated when the aneurysm reaches 5.0-5.5 cm or more, when symptomatic, or when increasing in size > 10 mm/year. AAA can be accurately assessed by cross-sectional imaging including computed tomography angiography and magnetic resonance angiography. Current options for intervention in AAA patients include open surgery and endovascular aneurysm repair (EVAR), with EVAR becoming more prevalent over time. Cross-sectional imaging plays a crucial role in AAA surveillance, pre-procedural assessment, and post-EVAR management. This paper will discuss the current role of imaging in the assessment of AAA patients prior to intervention, in evaluation of procedural complications, and in long-term follow-up of EVAR patients.
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Affiliation(s)
- Richard L Hallett
- Department of Radiology, Cardiovascular Imaging Section, Stanford University Hospital and Clinics, 300 Pasteur Drive, Grant Building, S-072, Stanford, CA, 94305, USA.
- St. Vincent Heart Center of Indiana, Indianapolis, IN, USA.
- Northwest Radiology Network, Indianapolis, IN, USA.
| | - Brant W Ullery
- Department of Cardiovascular Surgery, Providence Heart and Vascular Institute, Portland, OR, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University Hospital and Clinics, 300 Pasteur Drive, Grant Building, S-072, Stanford, CA, 94305, USA
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Fearn S, Lawrence-Brown MMD, Semmens JB, Hartley D. Follow-up after Endovascular Aortic Aneurysm Repair: The Plain Radiograph Has an Essential Role in Surveillance. J Endovasc Ther 2016; 10:894-901. [PMID: 14656185 DOI: 10.1177/152660280301000508] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Periodic follow-up is mandatory for patients with aortic stent-grafts. Central to surveillance is the establishment of a baseline against which changes can be detected. Computed tomography (CT) has been the benchmark of follow-up imaging for endografts, but comparison of serial AP and lateral plain radiographs will detect structural alterations that can be missed on CT scans. In this review, we illustrate these common endograft complications and the value of plain radiographs in their detection. We believe that the plain radiograph should be the cornerstone of aortic endograft surveillance. However, a standardized protocol should be used to avoid parallax and positioning errors that affect interpretation.
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Affiliation(s)
- Shirley Fearn
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Nedlands, Western Australia
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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Diagnostic imaging methods applied in long-term surveillance after EVAR. Will computed tomography angiography be replaced by other methods? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:6-12. [PMID: 26966443 PMCID: PMC4777700 DOI: 10.5114/pwki.2016.56943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/05/2015] [Indexed: 11/23/2022] Open
Abstract
Endovascular implantation of a stent graft in the abdominal aorta (endovascular aneurysm repair – EVAR) is a widely accepted alternative to open surgery in treatment of abdominal aortic aneurysms. Although EVAR is connected with a significant reduction in the risk of peri- and post-operative complications, it does not eliminate them totally. Long-term surveillance of post-EVAR patients is aimed at early detection of and fast reaction to a group of complications called endovascular leaks. Currently, the gold standard in leak diagnostics is computed tomography angiography (CTA). The other methods are ultrasonography, magnetic resonance (MR) angiography, intra-aneurysm sac pressure measurement, X-ray, and digital subtraction angiography (DSA). Despite many analyses based on long-term research, emphasising the high value and competitiveness of less invasive tests such as US or X-ray compared to CTA, it is still difficult for them to win the trust and acceptance of clinicians. The persisting view is that computed tomography is the test that finally resolves any inaccuracies. Consequently, a patient with a number of concurrent diseases is subject to absurdly high radiation exposure and effects of a radiocontrast agent within a short time. It is therefore logical to acknowledge that the EVAR-related risk is catching up with the open surgery risk, while the endovascular procedure is much more costly. Nevertheless, the status of CTA as the gold standard ultimately seems to be unthreatened. This paper presents a description of the diagnostic imaging tests that make it possible to detect any vascular leaks and to develop strategies for therapeutic processes.
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Abstract
There is a significant risk of complication following endovascular abdominal repair (EVAR), including endoleak, graft translocation, thrombosis, and infection. Surveillance imaging is important for detecting EVAR complication. Surveillance modalities include conventional X-ray, computed tomography, magnetic resonance imaging, ultrasound, and conventional angiography, with inherent advantages and drawbacks to each modality. The authors present common complications following EVAR, and recent advances in the key modalities for surveillance.
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Affiliation(s)
- Nirnimesh Pandey
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I Litt
- Department of Radiology, Cardiovascular Imaging Section, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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Moraes Filho D, Trevisan FB, Silvestre JMDS, Sardinha WE, Ramires ED, Dias SVM, Matsuda H. Vascular ultrasonography for follow-up of endovascular repair of abdominal aorta aneurysms. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BackgroundThere is little information available on follow-up of abdominal aortic aneurysm patients treated with endovascular repair using vascular ultrasonography in Brazil or on how it compares with the results of angiotomography. Since ultrasonography is an examination that is risk-free, inexpensive and widely available, it is a very attractive method. In this study we attempted to evaluate the sensitivity and specificity of vascular ultrasonography for follow-up of these patients by comparing the method with angiotomography.Materials and methodsWe conducted a prospective study from June 2012 to May 2013. We examined patients followed-up at the endovascular surgery clinic run by the University Hospital of Londrina after endovascular repair of abdominal aortic aneurysms. All patients underwent angiotomography for follow-up and were also examined using simple abdominal X-rays and vascular ultrasonography.ResultsA total of 30 patients were analyzed, with a mean age of 73 years and a mean aneurysm diameter of 6 cm. Four endoleaks were detected. Vascular ultrasonography achieved sensitivity of 75% and specificity of 96% for classification of these endoleaks, in comparison with angiotomography.ConclusionsVascular ultrasonography is an excellent primary method for evaluation and post-surgical follow-up of patients treated with endovascular repair of abdominal aorta aneurysms. However, when ultrasonography detects problems or is difficult to accomplish, it should be supplemented with a more specific investigation for diagnostic confirmation.
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Iezzi R, Santoro M, Dattesi R, Pirro F, Nestola M, Spigonardo F, Cotroneo AR, Bonomo L. Multi-detector CT angiographic imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair (EVAR). Insights Imaging 2012; 3:313-21. [PMID: 22695949 PMCID: PMC3481079 DOI: 10.1007/s13244-012-0173-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/20/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Multidetector computed tomography (MDCT) angiography represents the standard of reference in the follow-up of patients after endovascular abdominal aortic aneurysm repair (EVAR), being effective in the detection of the full spectrum of possible complications on both axial and 3D images. METHODS The purpose of this article is to review the normal CT angiography findings of the different types of stent-grafts and to describe the radiological findings of early and late complications after EVAR on axial and reconstructed images. A selection of cases of post-EVAR MDCT angiography is presented to learn the techniques most commonly used for endovascular treatment, the correct CT scanning technique to acquire the data, the full gamut of possible procedure-related complications and how these complications usually appear on CT images. CONCLUSION MDCT angiography is an effective and specific technique in both the pre- and postoperative settings of EVAR procedures. A better understanding of the procedure, the devices, the normal postoperative imaging features and the possible procedure-related complications ensures optimal planning and follow-up of patients undergoing an EVAR procedure.
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Affiliation(s)
- Roberto Iezzi
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, L.go A Gemelli 8, IT-00168, Rome, Italy,
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Harrison G, Oshin O, Vallabhaneni S, Brennan J, Fisher R, McWilliams R. Surveillance after EVAR Based on Duplex Ultrasound and Abdominal Radiography. Eur J Vasc Endovasc Surg 2011; 42:187-92. [DOI: 10.1016/j.ejvs.2011.03.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/23/2011] [Indexed: 11/24/2022]
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Shah A, Stavropoulos SW. Imaging Surveillance following Endovascular Aneurysm Repair. Semin Intervent Radiol 2011; 26:10-6. [PMID: 21326526 DOI: 10.1055/s-0029-1208378] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endoleaks are unique complications of endovascular aneurysm repair (EVAR) that necessitate lifelong imaging surveillance for the patient. Several imaging modalities may be used to monitor the patient for endoleaks and other complications related to the stent graft. At present, computed tomographic angiography remains the gold standard for the detection of endoleaks. Other modalities that can be used to detect endoleaks include magnetic resonance, ultrasonography, nuclear medicine techniques, and pressure monitoring. In addition, follow-up imaging with digital subtraction angiography is important for endoleak classification and to guide decisions regarding therapy. In this article, we review the classification of endoleaks and discuss the different imaging strategies available for post-EVAR surveillance.
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Affiliation(s)
- Anand Shah
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Bastos RM, Razuk Filho A, Blasbalg R, Caffaro RA, Karakhanian WK, Rocha AJ. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair. Clinics (Sao Paulo) 2011; 66:2025-9. [PMID: 22189725 PMCID: PMC3226595 DOI: 10.1590/s1807-59322011001200005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/18/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.
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Mohammadi Tofigh A, Ghasemi M, Aghdam BH, Karvandi M, Kaboli A. Endovascular treatment of thoracoabdominal aortic aneurysm: a case report. J Med Case Rep 2010; 4:37. [PMID: 20205854 PMCID: PMC2825520 DOI: 10.1186/1752-1947-4-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/02/2010] [Indexed: 12/04/2022] Open
Abstract
Introduction Thoracoabdominal aortic aneurysms usually present in elderly patients with serious renal, pulmonary, cerebral, or cardiac comorbidities that pose a great challenge to the attending surgeon. Endovascular techniques for the treatment of thoracoabdominal aneurysms are not yet widely used due to limitations associated with them, such as spinal and visceral ischemia. Case presentation An 87-year-old Caucasian man with a symptomatic Crawford type I thoracoabdominal aortic aneurysm was treated successfully with a long tube stent graft using endovascular techniques and without any complication in follow-up examinations. The stent was placed distal to the left subclavian artery, and proximal to the celiac axis. Conclusion The use of endovascular stents for long segment thoracoabdominal aortic aneurysms needs to undergo clinical investigation to determine whether this procedure decreases morbidity and mortality rates.
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Murphy M, Hodgson R, Harris PL, McWilliams RG, Hartley DE, Lawrence-Brown MMD. Plain radiographic surveillance of abdominal aortic stent-grafts: the Liverpool/Perth protocol. J Endovasc Ther 2004; 10:911-2. [PMID: 14656183 DOI: 10.1177/152660280301000510] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To present a protocol for plain radiographic surveillance of abdominal aortic stent-grafts that addresses the main variables in need of standardization: (1) patient position, (2) radiographic centering point, and (3) focus-to-film distance. TECHNIQUE Our policy is to perform baseline anteroposterior and lateral films following endoluminal grafting and repeat the studies annually. These are the most important films to assess migration and component separation; supplementary right and left posterior oblique radiographs may help identify wireform fractures. It is best to perform radiography before computed tomography if both tests are scheduled for the same day, as excretion of intravenous contrast opacifies the renal collecting systems and interferes with radiographic analysis. CONCLUSIONS Evaluation of the radiographs depends on the design of the stent-graft, so it is important to understand graft construction and the position of the radiopaque markers to best assess changes on follow-up films.
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Affiliation(s)
- Micheal Murphy
- Department of Interventional Radiology, Royal Liverpool University Hospital, England, UK
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Fearn S, Lawrence-Brown MMD, Semmens JB, Hartley D. Follow-Up After Endovascular Aortic Aneurysm Repair: The Plain Radiograph Has an Essential Role in Surveillance. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0894:faeaar>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Murphy M, Hodgson R, Harris PL, McWilliams RG, Hartley DE, Lawrence-Brown MMD. Plain Radiographic Surveillance of Abdominal Aortic Stent-Grafts: The Liverpool/Perth Protocol. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0911:prsoaa>2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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