Endoleak after endovascular aneurysm repair: Duplex ultrasound imaging is better than computed tomography at determining the need for intervention

Schmieder, Greg C.; Stout, Chris E.; Stokes, Gordon K.; Parent, F. Noel; Panneton, Jean M.

doi:10.1016/j.jvs.2009.06.021

Cited by 60 publications

(67 citation statements)

References 21 publications

(26 reference statements)

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“…26,27 The role of CDU in surveillance of EVAR patients has also been described in other published reports. [28][29][30] Aneurysm sac shrinkage (Ն5 mm) was noted in 62.2% of patients. A significant increase in aneurysm sac diameter (Ն5 mm) was seen in 25 patients (17.5%) and was associated with the risk of aneurysm rupture and the need for reintervention.…”

Section: Discussionmentioning

confidence: 99%

Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft

Mertens¹,

Houthoofd²,

Daenens³

et al. 2011

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft

Mertens¹,

Houthoofd²,

Daenens³

et al. 2011

Journal of Vascular Surgery

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“…26 Thus, the accuracy of duplex imaging may negate the requirement for regular CT, particularly for type II endoleaks in the presence of decreasing sac size. 27 Although type I and III endoleaks may require intervention, further research into flow characteristics of type II endoleak may allow patient selection for reintervention to be decided on duplex criteria. This alternative follow-up option may be especially relevant in younger patients to reduce the longterm carcinogenic risks of radiation exposure but is less pertinent for older patients because of the recognized latency period.…”

Section: Discussionmentioning

confidence: 99%

The impact of radiation dose exposure during endovascular aneurysm repair on patient safety

Jones¹,

Badger²,

Boyd³

et al. 2010

Journal of Vascular Surgery

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“…To our knowledge this has never before been described in this type of aneurysm. Surveillance is essential to detect endoleaks early and we adopt a combined approach using CT angiogram and six monthly duplex ultrasound, which has been shown to have a high sensitivity at detecting endoleaks [16,17]. Overall we feel the best approach to treatment of Type II endoleaks is one that is safe, effective and tailored to the specific circumstances and anatomy of the patient.…”

Section: Discussionmentioning

confidence: 99%

A novel approach to the management of a ruptured Type II endoleak following endovascular repair of an internal iliac artery aneurysm

Patel¹,

Perera²,

Law³

et al. 2011

BJR

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ABSTRACT. Endovascular repair of isolated iliac artery aneurysms is an established safe and effective management option. Type II endoleak is a potential complication, but rarely results in significant morbidity or mortality. We report a case of a patient who presented with a ruptured internal iliac artery aneurysm secondary to a Type II endoleak. To our knowledge this and the following method of managing this have not been previously reported. Established methods of managing endoleaks, such as intravascular transfemoral embolisation and open or laparoscopic ligation, were not possible. Therefore, we resorted to a novel approach to this type of aneurysm and successfully performed a transcutaneous direct puncture and embolisation of the superior gluteal artery. Isolated iliac artery aneurysms (IAAs) are rare, with an incidence rate as low as 0.03% in large autopsy series [1]. These aneurysms represent approximately 2-7% of all intra-abdominal aneurysms [2,3]. Iliac artery dilatation is regarded as aneurismal if it is .25 mm in diameter [4] and repair should be considered for aneurysms greater than 324 cm [3,5]. Over the past decade, endovascular iliac aneurysm repair has been established as a safe and effective alternative to open repair in patients with appropriate anatomy [3,5,6]. A Type II endoleak is one of the complications of endovascular repair and arises due to the persistence of pressurised flow in iliolumbar and sacral arteries. Type II endoleaks are found in up to 20% of cases following endovascular repair [7,8]. Although in most cases Type II endoleaks are considered benign [9], intervention becomes necessary when there is significant expansion of the sac [8] and, subsequently, increased risk of rupture. We report a case of a ruptured IAA secondary to a Type II endoleak and describe a percutaneous technique to embolise the endoleak. To the best of our knowledge, neither has been previously described in relation to an IAA. Case reportAn 84-year-old female presented with a reduced level of consciousness, acute onset abdominal pain and vaginal bleeding for several weeks. Initial assessment revealed that the patient was confused and disorientated, with a Glasgow coma score of 13. The patient was hypotensive (91/49), tachycardic (110) and pyrexial (37.9 u C). Heart sounds were normal, the chest was clear and an abdominal examination revealed tenderness and guarding mostly in the left lower quadrant. Initial investigations revealed haemoglobin (Hb) of 7.7 g dl . Urine dipstick analysis was positive for leukocytes, nitrites, protein and blood. The patient was resuscitated with intravenous (IV) fluids and IV piperacillin and tazobactam was commenced to treat the urinary tract infection. Subsequent urine culture revealed an Enterobacter infection.The patient's medical history included bilateral internal iliac artery aneurysms (IIAAs), chronic renal failure with a left-sided hydronephrosis and ureteric stent in situ, hypertension and ischaemic heart disease. 2 years previously an occlusion of the left IIAA was p...

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Endoleak after endovascular aneurysm repair: Duplex ultrasound imaging is better than computed tomography at determining the need for intervention

Cited by 60 publications

References 21 publications

Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft

Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft

The impact of radiation dose exposure during endovascular aneurysm repair on patient safety

A novel approach to the management of a ruptured Type II endoleak following endovascular repair of an internal iliac artery aneurysm

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