Best Practice Guidelines: Imaging Surveillance After Endovascular Aneurysm Repair

Smith, Tyler; Quencer, Keith

doi:10.2214/ajr.19.22197

Cited by 30 publications

(23 citation statements)

References 71 publications

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“…After EVAR, patients require lifelong surveillance involving regular multiphasic CT angiography (CTA) examinations. For the confident exclusion of endoleaks, a triphasic scan protocol is frequently applied, comprising a non-contrast acquisition followed by an arterial Diagnostics 2022, 12, 558 2 of 11 and venous phase scan [3]. These follow-up scans lead to substantial cumulative radiation exposure in this patient cohort [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

et al. 2022

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The purpose of this study was to evaluate virtual-non contrast reconstructions of Photon-Counting Detector (PCD) CT-angiography datasets using a novel calcium-preserving algorithm (VNCPC) vs. the standard algorithm (VNCConv) for their potential to replace unenhanced acquisitions (TNC) in patients after endovascular aneurysm repair (EVAR). 20 EVAR patients who had undergone CTA (unenhanced and arterial phase) on a novel PCD-CT were included. VNCConv- and VNCPC-series were derived from CTA-datasets and intraluminal signal and noise compared. Three readers evaluated image quality, contrast removal, and removal of calcifications/stent parts and assessed all VNC-series for their suitability to replace TNC-series. Image noise was higher in VNC- than in TNC-series (18.6 ± 5.3 HU, 16.7 ± 7.1 HU, and 14.9 ± 7.1 HU for VNCConv-, VNCPC-, and TNC-series, p = 0.006). Subjective image quality was substantially higher in VNCPC- than VNCConv-series (4.2 ± 0.9 vs. 2.5 ± 0.6; p < 0.001). Aortic contrast removal was complete in all VNC-series. Unlike in VNCConv-reconstructions, only minuscule parts of stents or calcifications were erroneously subtracted in VNCPC-reconstructions. Readers considered 95% of VNCPC-series fully or mostly suited to replace TNC-series; for VNCConv-reconstructions, however, only 75% were considered mostly (and none fully) suited for TNC-replacement. VNCPC-reconstructions of PCD-CT-angiography datasets have excellent image quality with complete contrast removal and only minimal erroneous subtractions of stent parts/calcifications. They could replace TNC-series in almost all cases.

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Section: Introductionmentioning

confidence: 99%

“…In theory, these could be used as a substitute for a prior 'true non-contrast' (TNC) acquisition [1,7]; in practice, however, studies reported diverging results [8][9][10][11][12][13][14]. Therefore, initial non-contrast scans are still widely performed in this clinical context [3].…”

Section: Introductionmentioning

confidence: 99%

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

et al. 2022

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“…4 , 24 , 45 The current recommendations propose imaging at 30 days after the procedure and yearly thereafter if no complications are detected. 46 The imaging modalities used for surveillance include CT angiography considered as the gold standard modality, duplex ultrasonography and magnetic resonance angiography. A large-scale study based on the nationwide English Hospital Episode Statistics database showed an increased risk of postoperative abdominal and all cancers in patients after EVAR in comparison to OSR.…”

Section: Discussionmentioning

confidence: 99%

Single centre experience with Excluder^® stent graft; 17-year outcome

Snoj

Tomazin

Salapura

et al. 2022

Radiology and Oncology

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Background Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed. Patients and methods This study included 123 patients (104 men; mean age 73.0 years, range 51–89) with abdominal aorta aneurysm, treated with Excluder® stent graft between October 2002 and June 2008. Periprocedural and follow-up data were retrieved by reviewing the records of our institution, while time and cause of death were retrieved from the National Institute of Public Health. If an abdominal aortic aneurysm rupture was listed as the cause of death, records were retrieved from the institution that issued the death certificate. Our primary goal was to assess the primary technical success rate, type 1 and type 2 endoleak, reintervention free survival, 30-day mortality, the overall survival and aneurysm rupture-free survival. Results The median follow-up was 9.7 years (interquartile range, 4.6–13.8). The primary technical success was 98.4% and the 30-day mortality accounted for 0.8%. Secondary procedures were performed in 29 (23.6%) patients during the follow-up period. The one-, five-, ten-, fifteen- and seventeen-year overall survival accounted for 94.3%, 74.0%, 47.2%, 35.8% and 35.8%, while the aneurysm-related survival was 98.4%, 96.3%, 92.6%, 92.6%, 92.6%. In seven (5.7%) patients, abdominal aortic rupture was found as the primary cause of death during follow-up. Conclusions Our data showed that EVAR with Excluder® stent graft offers good long-term results. More than 75% of patients can be treated completely percutaneously. Late ruptures do occur in the first ten years, raising awareness about regular medical controls.

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“…This is important for the diagnosis of early complications. For TEVAR, these complications include stroke, endoleaks, endograft collapse, vascular access and device delivery injuries, renal failure, aortoesophageal and aortobronchial fistulas, and device failure [ 67 , 68 ]. Additionally, for surgical thoracic aortic repair, the most common complications are anastomotic pseudoaneurysm, graft limb thrombosis, graft infection, and rarely, secondary aortic ruptures.…”

Section: Follow-up After Aortic Interventionmentioning

confidence: 99%

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Papakonstantinou

Benia

Polyzos

et al. 2022

Life

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Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.

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Best Practice Guidelines: Imaging Surveillance After Endovascular Aneurysm Repair

Cited by 30 publications

References 71 publications

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

Single centre experience with Excluder^® stent graft; 17-year outcome

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

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Best Practice Guidelines: Imaging Surveillance After Endovascular Aneurysm Repair

Cited by 30 publications

References 71 publications

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

Single centre experience with Excluder® stent graft; 17-year outcome

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

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Product

Resources

About

Single centre experience with Excluder^® stent graft; 17-year outcome