Endoleaks after Endovascular Repair of Aortic Aneurysm: Are They Predictable?—Initial Results

Görich, Johannes; Rilinger, N.; Sokiranski, Roman; Söldner, Joachim; Kaiser, Werner A.; Krämer, Stefan; Ermis, Cengiz; Schütz, Ansgar; Sunder‐Plassmann, L.; Pamler, Reinhard

doi:10.1148/radiology.218.2.r01fe13477

Cited by 68 publications

(45 citation statements)

References 13 publications

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“…These data are in good agreement with the results of other authors [18, 20, 22, 29 -31]. Interestingly, there is agreement regarding the critical number of perfused LAs for the development of a persistent endoleak which has been defined as 4 in preceding studies [22,31]. On average, there were 3.6 ± 1.2 LAs in the HRG in the present study.…”

Section: Vessels 51supporting

confidence: 93%

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

Löwenthal

Herzog

Rogits

et al. 2014

Fortschr Röntgenstr

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Purpose: An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR). Materials and Methods: Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n?=?80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n?=?50). Statistical analysis comprised a univariate and multivariate analysis. Results: Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4???3.8?mm; HRG 23.6???2.5?mm; p?=?0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7???18.0?%; HRG 25.3???17.5?%; p?=?0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3?%; HRG 92.0?%; p?=?0.003) and their diameter (LRG 3.3???0.7?mm; HRG 3.8???0.9?mm; p?=?0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7???1.4; HRG 3.6???1.2; univariate: p?=?0.01; multivariate: p?=?0.006) as well as their diameter (LRG 2.1???0.4?mm; HRG 2.4???0.4?mm; univariate: p?

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Section: Vessels 51supporting

confidence: 93%

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

Löwenthal

Herzog

Rogits

et al. 2014

Fortschr Röntgenstr

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“…It should be noted, however, that not all studies agree on which patent aortic branches are suitable predictors of type II endoleak development. Gorich et al (6) examined a relatively small sample of patients (7 type-II endoleaks in 68 EVAR patients) and managed to associate an increased risk of early type II endoleak with four or more patent lumbar arteries in the preoperative CTA without finding an association with the patency of other sac branches. Fan et al (7) studied immediate (i.e., at 72 hours) postoperative endoleaks and found that a patent IMA was a predisposing risk factor for type II endoleak development.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated potential correlations between preoperative characteristics of the aortic anatomy and the development of type II endoleaks following an EVAR (5)(6)(7)(8)(9). Although some studies failed to identify anatomic predictors for type II endoleak development (5), others with larger numbers of patients showed that preoperative patency of the aortic branches increases the possibility of type II endoleak development (6-9).…”

mentioning

confidence: 99%

Risk factors for the development of persistent type ii endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms

Brountzos

Karagiannis²,

Panagiotou³

et al. 2011

Diagn Interv Radiol

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E ndovascular aneurysm repair (EVAR) is universally accepted as an alternative to open surgery for the treatment of infrarenal abdominal aortic aneurysms because of its association with lower perioperative mortality and morbidity (1). The main drawback of EVAR is the relatively high rate of re-interventions (approximately 20%) required during the follow-up (1); endoleaks are usually the culprit responsible for these re-interventions. Type II endoleaks are most common, with a frequency varying from 10% to 25%, in EVAR procedures (2). They are caused by retrograde perfusion of the aneurysm sac from collateral aortic branches.In the majority of cases, type II endoleaks are benign and resolve spontaneously during follow-up. However, it has been shown both clinically and experimentally that type II endoleaks are associated with increased sac pressure (3). Interestingly, in a multivariate analysis from a series of 873 patients, it was documented that type II endoleak persisting for more than six months was a significant predictor of aneurysm rupture (P = 0.03) (4). Considering the lack of regularity in imaging follow-up, especially on a long-term basis, it is obvious that a small but existing minority of patients with untreated type II endoleaks may suffer from aneurysm rupture.Several studies have investigated potential correlations between preoperative characteristics of the aortic anatomy and the development of type II endoleaks following an EVAR (5-9). Although some studies failed to identify anatomic predictors for type II endoleak development (5), others with larger numbers of patients showed that preoperative patency of the aortic branches increases the possibility of type II endoleak development (6-9). Sampaio et al. (8) have not only focused on preoperative patent arteries but have also studied the aneurysm sac thrombus load in relation to type II endoleak development.The aim of our study was to define these potentially high-risk patients that are candidates for a more intense follow-up protocol. We have specifically focused on persistent type II endoleaks (present at six months after EVAR) because these of all type II endoleaks are implicated most frequently in late adverse outcomes (4). Based on previous studies, we investigated the role of preoperative patent aortic branches and sac thrombus formation as potential predictors of persistent (longer than six months) type II endoleak development. Materials and methods Patient populationOne hundred forty-nine patients (144 males, 5 females) with infrarenal abdominal aortic aneurysm (AAA) were treated with EVAR in our institution by a team of interventional radiologists, anesthesiologists, and vascular surgeons. Only patients that strictly adhered to the INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Risk factors for the development of persistent type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysmsElias Brountzos, Georgios Karagiannis, Irene Panagiotou, Chara Tzavara, Efstathios Efstathopoulos, Nikolaos KelekisFrom the 2nd Department o...

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“…6) [25e27]. EL is a common procedural failure due to persistent flow outside the graft within the aneurysm sac causing further enlargement and rupture of the aneurysm sac itself [9,28,29]. CT protocol considered most reliable in detecting complications consists of a triphasic protocol including unenhanced, arterial phase (30-s delay), and delayed (120-to 300-s delay) phases, and it has been preferred for post-EVAR surveillance [8,9,25].…”

Section: Triphasic Cta In Post-evar Surveillancementioning

confidence: 99%

Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak

Reginelli

Capasso

Ciccone

et al. 2016

International Journal of Surgery

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Endoleaks after Endovascular Repair of Aortic Aneurysm: Are They Predictable?—Initial Results

Abstract: Prediction of endoleaks with absolute certainty remains elusive. The single correlating risk factor identified from the data was patency of four or more lumbar arteries visualized preoperatively at CT.

Cited by 68 publications

References 13 publications

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

Risk factors for the development of persistent type ii endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms

Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak

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