Leakages after Endovascular Repair of Aortic Aneurysms: Classification Based on Findings at CT, Angiography, and Radiography

Görich, Johannes; Rilinger, N.; Sokiranski, Roman; Orend, Karl-Heinz; Ermis, Cengiz; Krämer, Stefan; Brambs, Hans‐Jürgen; Sunder‐Plassmann, L.; Pamler, Reinhard

doi:10.1148/radiology.213.3.r99dc04767

Cited by 124 publications

(80 citation statements)

References 20 publications

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“…There was relatively poor agreement between observers for the classification of EL which reflects the well-known difficulty of categorizing the precise type of EL on both CT and MR imaging [8,11]. The gold standard for classification of EL remains the digital subtraction angiography (DSA) [3,7], but this technique is recognized to have a limited sensitivity to identify EL with slow flow [5]. Therefore, MRI and MDCT represent the methods of choice for EL detection, which is reflected by the excellent interobserver agreement, but they are not as specific as DSA for endoleak classification.…”

Section: Discussionmentioning

confidence: 99%

Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms

et al. 2008

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This study compares MRI and MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms (EVAR). Forty-three patients with previous EVAR underwent both MRI (2D T1-FFE unenhanced and contrast-enhanced; 3D triphasic contrast-enhanced) and 16-slice MDCT (unenhanced and biphasic contrast-enhanced) within 1 week of each other for endoleak detection. MRI was performed by using a high-relaxivity contrast medium (gadobenate dimeglumine, MultiHance). Two blinded, independent observers evaluated MRI and MDCT separately. Consensus reading of MRI and MDCT studies was defined as reference standard. Sensitivity, specificity, and accuracy were calculated and Cohen's k statistics were used to estimate agreement between readers. Twenty endoleaks were detected in 18 patients at consensus reading (12 type II and 8 indeterminate endoleaks). Sensitivity, specificity, and accuracy for endoleak detection were 100%, 92%, and 96%, respectively, for reader 1 (95%, 81%, 87% for reader 2) for MRI and 55%, 100%, and 80% for reader 1 (60%, 100%, 82% for reader 2) for MDCT. Interobserver agreement was excellent for MDCT (k = 0.96) and good for MRI (k = 0.81). MRI with the use of a high-relaxivity contrast agent is significantly superior in the detection of endoleaks after EVAR compared with MDCT. MRI may therefore become the preferred technique for patient follow-up after EVAR.

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Section: Discussionmentioning

confidence: 99%

Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms

et al. 2008

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“…Currently, single or multiple-row spiral computed tomographic angiography (CTA), intraarterial digital subtraction angiography (DSA), and/or duplex sonography are used to exclude early and late complications associated with the stent-graft device and to assess aneurysm sac diameter changes. Computed tomographic angiography has been recommended as the modality of choice [1,2,3,4,5,6] and is the required method for the EUROSTAR registry [6]. The disadvantages of CTA are its contrast-medium-associated nephrotoxicity and its potential for anaphylactic reactions caused by iodinated contrast medium.…”

Section: Introductionmentioning

confidence: 99%

MR angiography vs CT angiography in the follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms

et al. 2002

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Our objective was to evaluate the accuracy of contrast-enhanced 3D MR angiography (MRA) in the follow-up of patients with endoluminally treated aortic aneurysms and correlate these findings with uni- or biphasic CT angiography (CTA). Forty MR angiograms in 32 patients with implanted aortic nitinol stent grafts were compared to CTA. Twenty-two MR examinations were correlated with arterial-phase CTA (uniphasic), and 18 MR examinations were correlated with biphasic CTA. Uniphasic CTA demonstrated three type-1/type-3 endoleaks and four reperfusion (type-2) endoleaks. In addition, MRA depicted two type-2 reperfusion endoleaks that were missed by CTA. Using biphasic CTA, two type-1/type-3 endoleaks and three reperfusion (type-2) endoleaks were detected; of those, delayed scanning detected three reperfusion (type-2) endoleaks missed during arterial-phase CTA. In addition to the findings by CTA, MRA depicted another type-2 reperfusion endoleak. Magnetic resonance angiography is at least as sensitive as uni- or biphasic CTA for detecting endoleaks and may consequently offer advantages in patients with contraindications to iodinated contrast agents.

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“…Even without any detectable endoleaks, and the aneurysm sac may grow due to endotension or undetectable endoleaks, this aneurysm sac may rupture and cause death. In the event of an aneurysm sac rupture, after a chimney procedure, no endovascular procedure is safe, and open surgery that was once avoided now has a higher risk and is characterized by even greater technical difficulties 3,5,[8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

“…The type-V endoleak, also called endotension, is defined by the persistent or recurrent pressurisation of the aneurysm sac through the parietal thrombi. What differentiates an endoleak from endotension is that, in the latter, pressure is transmitted without the presence of blood flow within the aneurysm [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

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Endotension: rupture of abdominal aortic aneurysm

et al. 2012

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Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.

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Leakages after Endovascular Repair of Aortic Aneurysms: Classification Based on Findings at CT, Angiography, and Radiography

Abstract: The cause of a leakage can be determined with CT on the basis of its configuration and location in the majority of cases.

Cited by 124 publications

References 20 publications

Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms

Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms

MR angiography vs CT angiography in the follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms

Endotension: rupture of abdominal aortic aneurysm

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