Magnetic Resonance Imaging is More Sensitive than Computed Tomography Angiography for the Detection of Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review

Habets, Jesse; Zandvoort, Herman J.A.; Reitsma, Johannes B.; Bartels, Lambertus W.; Moll, Frans L.; Leiner, Tim; Herwaarden, Joost A. van

doi:10.1016/j.ejvs.2012.12.014

Cited by 89 publications

(58 citation statements)

References 29 publications

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“…The sensitivity of contrast-enhanced ultrasonography for detecting endoleaks was reported to be 81%-98% (24,25). Magnetic resonance imaging was also reported as being more sensitive than CT angiography for the detection of endoleaks (26,27).…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair CARDIOVASCULAR IMAGINGORIGINAL ARTICLE PURPOSE We aimed to identify the risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair (EVAR). METHODSWe retrospectively reviewed contrast-enhanced computed tomography (CT) images of 143 patients who were followed for ≥6 months after EVAR. Sac expansion was defined as an increase in sac diameter of 5 mm relative to the preoperative diameter. Univariate and multivariate analyses were performed to identify associated risk factors for late sac expansion after EVAR from the following variables: age, gender, device, endoleak, antiplatelet therapy, internal iliac artery embolization, and preprocedural variables (aneurysm diameter, proximal neck diameter, proximal neck length, suprarenal neck angulation, and infrarenal neck angulation). RESULTSUnivariate analysis revealed female gender, endoleak, aneurysm diameter ≥60 mm, suprarenal neck angulation >45°, and infrarenal neck angulation >60° as factors associated with sac expansion. Multivariate analysis revealed endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angulation >60° as independent predictors of sac expansion (P < 0.05, for all). CONCLUSIONOur results suggest that patients with small abdominal aortic aneurysms (<60 mm) and infrarenal neck angulation ≤60° are more favorable candidates for EVAR. Intraprocedural treatments, such as prophylactic embolization of aortic branches or intrasac embolization, may reduce the risk of sac expansion in patients with larger abdominal aortic aneurysms or greater infrarenal neck angulation.T he aim of endovascular abdominal aortic aneurysm repair (EVAR) is to prevent rupture of an abdominal aortic aneurysm (AAA) by depressurizing the aneurysm and excluding it from the systemic circulation using a stent-graft. Aneurysmal sac reduction is a reliable marker for the long-term prognosis after EVAR. Although most aneurysmal sacs shrink after EVAR, some sacs continue to expand. A relationship between aneurysm size and endoleaks was previously reported (1, 2). Most type II endoleaks spontaneously disappear over time, but 10%-25% persist for more than six months after EVAR (3-6). Persistent endoleaks with aneurysmal sac expansion are at high risk of rupture because of the continuously elevated intra-aneurysmal pressure and require a second intervention, such as embolization (7-11). However, it is difficult to predict sac expansion and persistent endoleak before performing EVAR. Although intraoperative intrasac thrombin injection and prophylactic embolization of aortic branches such as the inferior mesenteric artery and lumbar artery are reported to reduce the incidence of type II endoleak, the efficacy and clinical benefit of these procedures in terms of late postoperative aneurysm shrinkage have not been fully evaluated (12)(13)(14)(15). Therefore, the purpose of this study was to identify the risk factors associated with late...

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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“…The percentage of endoleaks after EVAR is generally reported to be 20-30 %, but endoleaks may be more common than previously believed [11,12]. That is, completion aortography sometimes fails to detect the presence of endoleaks.…”

Section: Discussionmentioning

confidence: 98%

Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

Koike

Nishimura

Hase

et al. 2014

Cardiovasc Intervent Radiol

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Purpose The purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients. Methods A retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing. Results Sac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.

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“…One such method, contrast enhanced magnetic resonance imaging (CE-MRI), holds promise for this purpose, as has been shown in a recent meta-analysis, which found that CE-MRI is more sensitive than CTA for the detection of endoleaks, especially for slow flow/type II endoleaks. 6 This is important because type II endoleaks are not always harmless as they may result in adverse outcome after EVAR including rupture. 7,8 Besides standard gadolinium contrast agents, albumin binding contrast agents can be used for MRI examinations aimed at the detection of endoleaks.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging with a Weak Albumin Binding Contrast Agent can Reveal Additional Endoleaks in Patients with an Enlarging Aneurysm after EVAR

Habets

Zandvoort

Moll

et al. 2015

European Journal of Vascular and Endovascular Surgery

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Magnetic Resonance Imaging is More Sensitive than Computed Tomography Angiography for the Detection of Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review

Abstract: MRI is more sensitive compared to CTA for the detection of post-EVAR endoleaks, especially for the detection of type II endoleaks. MRI should be considered in patients with continued AAA growth and negative or uncertain findings at CTA.

Cited by 89 publications

References 29 publications

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

Magnetic Resonance Imaging with a Weak Albumin Binding Contrast Agent can Reveal Additional Endoleaks in Patients with an Enlarging Aneurysm after EVAR

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