Endotension: What do we know and not know about this enigmatic complication of endovascular aneurysm repair

Parsa, Pouria; Gupta, Jaideep Das; McNally, Michael M.; Chandra, Venita

doi:10.1016/j.jvs.2021.03.018

Cited by 18 publications

(27 citation statements)

References 41 publications

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“…In the course of further progress, stentgrafts include a second layer of low permeability PTFE to decrease the risk of type IV EL. 14 The next invention was polimer (polyethylene Glycol) coverage. Over time, polymer has been used in two techniques: the first one uses the polymer-filled endobags, the so-called Endovascular Aneurysm Sealing (EVAS) with Nellix stentgraft, while the second uses the O-ring polymer-based proximal neck sealing device, the so-called Ovation stentgraft.…”

Section: Discussionmentioning

confidence: 99%

“…The literature has highlighted that endotension is in fact the type II or III EL below the sensitivity limits of current imaging modalities. 14 Either way, an ASP measurement can detect EL, whatever its cause, so the diagnosis and proper treatment may be initiated. 8,15 In contrast to investigators who assessed ASP a few months after treatment, we performed perioperative measurements.…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Assessment of Intra-Aneurysm Sac Pressure During Endovascular Aneurysm Repair as an Early Prognostic Factor of Aneurysm Enlargement

Antkiewicz¹,

Protasiewicz²,

Kuliczkowski³

et al. 2022

VHRM

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Purpose Numerous cases of abdominal aortic aneurysm (AAA) enlargement, and even rupture, despite endovascular aneurysm repair (EVAR), have been documented. This has been linked to increased aneurysm sac pressure (ASP). We decided to conduct further research with the aim to identify correlations between ASP during EVAR and subsequent aneurysm enlargement. Patients and Methods This experimental prospective study included 30 patients undergoing EVAR of infrarenal AAAs. Invasive ASP measurements were done using a thin pressure wire. Aortic pressure (AP) was measured using a catheter placed over the wire. Systolic pressure index (SPI), diastolic pressure index (DPI), mean pressure index (MPI), and pulse pressure index (PPI) were calculated both for ASP and AP. The results of follow-up computed tomography angiography (CTA) at 3 months were compared with baseline CTA findings. Results During EVAR, a significant reduction was observed for SPI (from 98% to 61%), DPI (from 100% to 87%), MPI (from 99% to 74%), and PPI (from 97% to 34%). There were no significant correlations of pressure indices with an aneurysm diameter, cross-sectional area, velocity, thrombus shape and size, number of patent lumbar arteries, length and diameter of aneurysm neck, diameter of the inferior mesenteric artery, as well as diameter and angle of common iliac arteries. On the other hand, aneurysm neck angulation was significantly inversely correlated with reduced PPI. After combining CTA findings with pressure measurements, we identified a positive correlation between PPI and aneurysm enlargement (ratio of the cross-sectional area at the widest spot at baseline and at 3 months after EVAR). Conclusion The study showed that ASP can be successfully measured during EVAR and can facilitate the assessment of treatment efficacy. In particular, PPI can serve as a prognostic factor of aneurysm enlargement and can help identify high-risk patients who remain prior monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preliminary Assessment of Intra-Aneurysm Sac Pressure During Endovascular Aneurysm Repair as an Early Prognostic Factor of Aneurysm Enlargement

Antkiewicz¹,

Protasiewicz²,

Kuliczkowski³

et al. 2022

VHRM

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“…Manche Arbeitsgruppen beschreiben ultrafiltriertes Plasma (im Gegensatz zu Blut mit zellulären Anteilen) als Inhalt des Aneurysmasacks [ 57 ]. Als Ursache kommen mechanische (Pulsationen), osmotische oder andere noch nicht gänzlich erforschte Mechanismen in Frage [ 47 , 48 ].…”

Section: Typ Vunclassified

Endovaskuläre Aortenreparatur bei Endoleaks

Hauck

Schernthaner²,

Dachs

et al. 2022

Radiologie

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ZusammenfassungSämtliche Patienten nach endovaskulärer Versorgung eines Aortenaneurysmas bedürfen einer regelmäßigen Nachkontrolle, zumeist in jährlichem Abstand. Der kontrastmittelverstärkte Ultraschall und die Computertomographie-Angiographie (CTA) sind die wichtigsten diagnostischen Modalitäten für die Erkennung von Endoleaks. Die (CTA) erlaubt eine bessere Unterscheidung der verschiedenen Endoleak-Typen. Sogenannte Hochdruck-Endoleaks (Typ I und Typ III) stellen, wenn sich nicht kurzzeitig ein Spontanverschluss zeigt, eine absolute Indikation zur Nachbehandlung dar. Typ-II-Endoleaks weisen in der Mehrzahl einen benignen Verlauf auf. Wenn kein Wachstum des Aneurysmasacks erfolgt, kann eine Nachkontrolle im gewohnten Intervall durchgeführt werden. Typ-II-Endoleaks mit assoziiertem Wachstum des Aneurysmasacks können durch Embolisation der verantwortlichen Gefäße behandelt werden. Ob eine Behandlung immer durchgeführt werden muss, ist umstritten. Eine Behandlungsindikation von einem Typ-II-Endoleak mit wachsendem Aneurysmasack ist jedoch gegeben, wenn durch eine Verkürzung des Aneurysmahalses ein sekundäres Typ-I-Endoleak droht. Typ-I-Endoleaks stellen die Hauptlimitation der Stentgraft-Therapie dar. Die beste Prävention eines Typ-I-Endoleaks ist die Bereitstellung einer adäquaten proximalen Landezone. Dies kann durchaus bedeuten, dass fenestrierte Stentgrafts verwendet werden müssen. Die Verwendung von Schrauben oder anderen Fixationsinstrumenten zur sicheren Behandlung auch kurzer Hälse ist derzeit noch in der Studienphase.

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“…Endotension or type V 'endoleak' is a poorly understood phenomenon describing aortic sac expansion in the absence of detectable endoleak. 1 A nasogastric (NG) tube was placed for decompression, and adequate resuscitation and maintenance were implemented. Electrolyte imbalances were corrected, and total parenteral nutrition was instituted.…”

Section: Descriptionmentioning

confidence: 99%

Aortoduodenal syndrome: a rare cause of duodenal obstruction postabdominal aortic aneurysm repair

et al. 2022

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Endotension: What do we know and not know about this enigmatic complication of endovascular aneurysm repair

Cited by 18 publications

References 41 publications

Preliminary Assessment of Intra-Aneurysm Sac Pressure During Endovascular Aneurysm Repair as an Early Prognostic Factor of Aneurysm Enlargement

Preliminary Assessment of Intra-Aneurysm Sac Pressure During Endovascular Aneurysm Repair as an Early Prognostic Factor of Aneurysm Enlargement

Endovaskuläre Aortenreparatur bei Endoleaks

Aortoduodenal syndrome: a rare cause of duodenal obstruction postabdominal aortic aneurysm repair

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