Imaging Techniques for Detection and Management of Endoleaks after Endovascular Aortic Aneurysm Repair¹

Abstract

Endovascular aortic aneurysm repair (EVAR) is evolving into a viable alternative to open surgical repair for many patients with abdominal and thoracic aortic aneurysms. Endoleak development is a complication of EVAR and represents one of the limitations of this procedure. Endoleaks represent blood flow outside the stent-graft lumen but within the aneurysm sac. Lifelong imaging surveillance of patients after EVAR is critical to detect endoleaks for the patient's benefit and to determine the long-term performance of the stent-graft. Although computed tomographic angiography is the most commonly used examination for imaging surveillance, magnetic resonance angiography, ultrasonography, and digital subtraction angiography all have a role in endoleak detection and management. This review will focus on imaging techniques used for endoleak detection and the role imaging surveillance plays in the overall care of the post-EVAR patient.

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

“…This retrospective study for evaluating the success of endovascular treatment with the positioning of metal endoprosthesis (EVAR) was conducted because the present follow-up modalities still represent a controversial issue [9,17,19]. An alternative could be baseline ultrasound which would show an enhancement of the residual aneurysmal sac.…”

“…At the moment, triphasic CT is considered the reference procedure in the follow-up of patients who have undergone EVAR, because it allows a good identification of endoleaks [18,19,22]. Pre-and post-contrast scans in the arterial phase allow the identification of small endoleaks adjacent to the metal parts and calcifications, and lowflow endoleaks, visible in delayed scans.…”

Successful Endovascular Treatment with Covered Stent for Iatrogenic Vertebral Arteriovenous Fistula

“…1) In our patient, a slight endoleak was observed immediately after treatment, but attachment to the vessel was satisfactory, and no clear graft failure was observed on high-resolution cone-beam computed tomography. The advance placement of a Precise covered stent may have some effect on endoleak development.…”

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

“…The MDCTA dataset, in combination with a variety of 2D and 3D postprocessing options, allows an accurate qualitative and quantitative assessment of the vascular structures. Therefore, MDCTA is nowadays well accepted for pre-and postprocedural aortic aneurysm imaging [16,17].…”