Increased Fluorodeoxyglucose Uptake Following Endovascular Abdominal Aortic Aneurysm Repair: A Predictor of Endoleak?

Abstract

The main criterion for abdominal aortic aneurysm (AAA) repair is an AAA diameter ≥5.5 cm. However, some AAAs rupture when they are smaller. Size alone may therefore not be a sufficient criterion to determine rupture risk. Fluorodeoxyglucose (FDG) uptake is increased in the presence of inflammation and it was suggested that this may be a better predictor of rupture risk than AAA size. Furthermore, increased FDG uptake following endovascular AAA repair may be an indirect predictor of continuous AAA sac enlargement due to the presence of an endoleak (even if this is not detected by imaging modalities) and/or increased AAA rupture risk. The role of FDG uptake needs to be explored further in the management of AAAs.

FDG Uptake Pattern on PET/CT Imaging in Non-Infectious Graft of a Patient with Operated Abdominal Aortic Aneurysm

“…A diameter of ≥ 5.5 cm is the main criterion for abdominal aortic aneurysm repair. Increased FDG uptake in the presence of inflammation was suggested that this may be a better predictor of rupture risk than aneurysm size (10). In a prospective study by Keidar Z et al (11), a total of 39 patients with 69 grafts (range 1-4 grafts/patient) were evaluated using FDG-PET/CT.…”

Aneurysm sac shrinkage after endovascular treatment of the aorta: Beyond sac pressure and endoleaks

“…42 Therefore, the role of 18-FDG needs to be investigated further in the post-EVAR course, in order to delineate its potential role as a predictor of endoleaks. 42,43 …”

18F-FDG PET/CT Detected Delayed Endoleak in an Aortoiliac Endovascular Aneurysm Repair

“…7 Increased FDG uptake involving the aortic wall, resulting from inflammation, has been suggested to be a predictor for an endoleak and AAA rupture risk. 8 Recently, early, dynamic PET/CT and PET angiography for endoleak detection after EVAR has been proposed 9 although is only likely to find utility if intravenous contrast is contraindicated. Given the increasing use of endovascular techniques for the repair of AAA, with their associated endoleaks, the recognition of delayed endoleaks, outside of routine CT surveillance programmes, on PET/CT scans performed for other indications is of critical importance.…”