Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis

Katahashi, Kazuto; Sano, Masaki; Takehara, Yasuo; Inuzuka, Kazunori; Sugiyama, Masataka; Alley, Marcus T.; Takeuchi, Hiroya; Unno, Naoki

doi:10.1016/j.jvs.2018.09.048

Cited by 24 publications

(18 citation statements)

References 32 publications

(42 reference statements)

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“…It is the authors' view that persistent T2EL and related sac expansion were determined by the flow dynamics of the culprit vessels. The flow field of the aneurysm sac, 19 and heavy IMT load were found to be protective factors of T2EL.…”

Section: Discussionmentioning

confidence: 89%

Editor's Choice – Mid Term Outcomes of Crossed Limb vs. Standard Limb Configuration in Endovascular Abdominal Aortic Aneurysm Repair: A Propensity Score Analysis

Wang

Zhao

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis cohort study with inverse probability of treatment weighting analyses suggests that endovascular aortic aneurysm repair (EVAR) with crossed limb (CL) configuration is safe and effective in general patients with abdominal aortic aneurysm and may decrease the risk of type IB endoleak in patients with a large aneurysm sac or tortuous iliac arteries. However, the application of the CL technique in patients with a severely angulated neck may be associated with a higher risk of re-intervention due to potential higher risks of adverse limb events.Objective: The aim was to compare mid term outcomes between crossed limb (CL) and standard limb (SL) configuration in patients who underwent endovascular aortic aneurysm repair (EVAR). Methods: This was a comparative cohort study. Eligible patients who underwent EVAR between September 2011 and March 2019 in a tertiary academic centre were included. Inverse probability of treatment weighting (IPTW) was used to balance the demographic, anatomical and operative baseline characteristics between the two groups. The primary outcome was adverse limb events including type IB endoleak (T1BEL), type III endoleak, and limb occlusion. Cox proportional hazards regression and marginal structural model were performed to compare time to event outcomes. Results: The study included 729 patients (194 CL and 535 SL) with a median follow up of 34 months (interquartile range 16 e 62 months). The weighted analyses revealed no significant difference between CL and SL EVAR in terms of adverse limb events, type IA endoleak (T1AEL), type II endoleak (T2EL), re-intervention, and overall survival. In the subgroup analysis of large aneurysm sac, the CL configuration was associated with a significantly decreased risk of T1BEL (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12 e 0.78, p ¼ .014). Similar results were also observed in the subgroup of tortuous iliac arteries (HR 0.30, 95% CI 0.11 e 0.81, p ¼ .017). After stratification by severe neck angulation, no significant difference was found between CL and SL EVAR for T1AEL, but the CL configuration was associated with a significantly increased risk of reintervention (HR 2.69, 95% CI 1.31 e 5.51, p ¼ .007). In addition, a trend towards a higher risk of adverse limb events in the CL group with severely angulated proximal neck was observed. Conclusion: CL configuration in EVAR is safe and may be associated with a lower risk of T1BEL in patients with a large aneurysm sac or tortuous iliac arteries. However, it should be applied cautiously to aneurysms with a severely angulated neck due to the potentially higher risk of re-intervention.

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Section: Discussionmentioning

confidence: 89%

Editor's Choice – Mid Term Outcomes of Crossed Limb vs. Standard Limb Configuration in Endovascular Abdominal Aortic Aneurysm Repair: A Propensity Score Analysis

Wang

Zhao

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“…In this study, preoperative endoleak type was diagnosed by CT, CTA, and angiography performed every 1 ~ 12 months after EVAR. It has been suggested that four-dimensional ow-sensitive MRI after EVAR was useful for identifying the type of endoleak and predicting dilatation of the aneurysm one year later [21], however there were limitations in the number of facilities available for testing and the inability to test with stainless stent-grafts. Contrastenhanced ultrasound may be highly accurate in detecting and classifying endoleaks.…”

Section: Discussionmentioning

confidence: 99%

Title: Preoperative Endoleak Type in Patients of Aneurysmal Sac Expansion After Endovascular Aneurysm Repair and Intraoperative Blood Loss in Aneurysmorrhaphy: Analysis of a Case Series of 18 Patients

Oshida¹,

Ikeda²,

Shibuya³

et al. 2021

Preprint

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Purpose EVAR (endovascular aneurysm repair) has become a possible treatment option of abdominal aortic aneurysms, and endoleak is the most common complication after EVAR. The purpose of this study was to determine the difference of intraoperative blood loss in aneurysmorraphy for aneurysmal sac expansion after EVAR according to type of endoleak. Methods Perioperative data of 18 patients underwent aneurysmorrhaphy for aneurysmal sac expansion after EVAR from July 2010 to November 2017 at the Jikei University Hospital are collected. Patients were divided in two group, endoleak type II or type V (endotension) according to preoperative imaging. Patient demographic and quantitative data, including intraoperative blood loss and intraoperative red blood cell transfusion volume, were collected from electronic medical and anesthetic records. Intraoperative blood loss in aneurysmorrhaphy were compared between the two groups. Results In 18 patients, 13 patients were diagnosed type II endoleak, and 5 patients were diagnosed endotension. There were statistically differences in intraoperative blood loss and red cell transfusion volume between type II endoleak and endotension groups (P = 0.0016 and P = 0.018, respectively). Conclusion These results suggest that the type of endoleak after EVAR may be associated with intraoperative blood loss in aneurysmorrhaphy. Pre-operative estimation of intraoperative blood loss depending on endoleak type may be helpful for the decision making of anesthetic management in aneurysmorrhaphy.

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“…For the LA, coil embolization can be performed at a high success rate if the orthogonal aortic diameter is less than 36 mm. In 2018, a 4 dimensional-flow magnetic resonance imaging method of identifying branches causing T2EL aneurysm enlargement after EVAR surgery 28) was reported. In the future, methods to identify the aortic branches that cause T2EL prior to EVAR should be developed.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factor of the Possibility for Aortic Side Branches Coil Embolization during Endovascular Abdominal Aortic Aneurysm Repair

Aoki

Maruta

Hosaka

et al. 2020

Annals of Vascular Diseases

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Objective: Coil embolization of aortic side branches has been additionally performed to prevent type II endoleak during EVAR in our institute. In this study, we evaluated the predictive factors of the possibility for coil embolization of the inferior mesenteric artery (IMA) and lumbar artery (LA) during EVAR. Methods: Seventy-four EVAR patients during June 2015 and April 2019 were included in the study. The coil embolization procedural time for one vessel is limited to 10 min. Aortic side branches were selected with 4 Fr Shepherd hook type catheter (Medikit, Tokyo, Japan) and were embolized with Interlock (Boston Scientific, MA, USA) via microcatheter. As predictive factors, internal diameter of aortic side branches and the aortic diameter perpendicular to the origin of LA (aortic diameter) were evaluated. Results: Coil embolization was tried for 52 patent IMAs and all IMAs except two IMAs with ostial stenosis were successfully coil embolized (96.2%). Totally 190 LAs were patent and coil embolization was tried for 144 LAs. Among 144 LAs, 106 LAs (73.6%) were successfully coil embolized and the diameter was significantly longer (2.30±0.51 mm vs. 2.04±0.41 mm, p=0.007) and aortic dimeter was significantly shorter (30.0±8.1 mm vs. 40.5±11.6 mm, p<0.001) in successfully embolized LAs. Cut off value of successful LA coil embolization was 2.06 mm for internal diameter and 36.1 mm for aortic diameter by receiver operating characteristic curve analysis. Successful coil embolization rate for LAs with internal diameter longer than 2.0 mm and aortic diameter less than 36.2 mm was 90% (72 among 80 LAs). Conclusion: Coil embolization during EVAR for IMA was highly successful, if there was no calcified ostial stenosis. LA embolization was feasible especially for LAs with internal diameter ≥2.0 mm and aortic diameter ≤36.1 mm. This information would be useful to select the target vessel for aortic side branches coil embolization during EVAR.

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Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis

Cited by 24 publications

References 32 publications

Editor's Choice – Mid Term Outcomes of Crossed Limb vs. Standard Limb Configuration in Endovascular Abdominal Aortic Aneurysm Repair: A Propensity Score Analysis

Editor's Choice – Mid Term Outcomes of Crossed Limb vs. Standard Limb Configuration in Endovascular Abdominal Aortic Aneurysm Repair: A Propensity Score Analysis

Title: Preoperative Endoleak Type in Patients of Aneurysmal Sac Expansion After Endovascular Aneurysm Repair and Intraoperative Blood Loss in Aneurysmorrhaphy: Analysis of a Case Series of 18 Patients

Predictive Factor of the Possibility for Aortic Side Branches Coil Embolization during Endovascular Abdominal Aortic Aneurysm Repair

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