Late Sac Rupture due to a Type IV Endoleak after Previous Endovascular Aortic Aneurysm Repair: A Case Report

Filis, Konstantinos; Zarmakoupis, Constantinos; Karantzikos, Georgios; Sigala, Frangiska; Bazigos, Gerasimos; Galyfos, George

doi:10.3389/fsurg.2017.00045

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…CT findings showed that the leakage site was close to the neck site, making it difficult to completely deny Type I because the neck was angulated and the endoleak was massive. A Type IV endoleak is usually observed without apparent contrast extravasation [ 8 , 9 ]. In the present case, the use of Viewtify and the stereoscopic display resulted in very clear 3DCG visualization.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Type IV Endoleak After Endovascular Aneurysm Repair Using Visualization With Novel Software

Nishi,

Kitahara,

Taguchi

et al. 2024

Cureus

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A Type IV endoleak is a very rare complication following endovascular aneurysm repair (EVAR) and differential diagnosis can be difficult. Reported here is a case that showed the development of a Type IV endoleak after an EVAR procedure, for which a novel software was useful to differentiate that from Type I based on visual confirmation. The 89-year-old man was diagnosed with a large abdominal aortic aneurysm, sized 70 mm, as shown by computed tomography (CT). EVAR was performed in a routine fashion using an Endurant II stent graft. Postoperative CT revealed a massive endoleak around the neck that was difficult to differentiate between Types I and IV. The use of the novel software Viewtify (SCIEMENT, Inc., Tokyo, Japan) to visualize the endoleak with surrounding tissues as real-time three-dimensional computer graphics (3DCG) resulted in confirmation that the endoleak was not from the proximal end but rather the stent graft body. CT findings obtained one week later showed that the endoleak had diminished and no additional procedures were needed. Following a diagnosis of endoleak after EVAR, images viewed with Viewtify helped to confirm the appropriate diagnosis. This novel software was found useful to clarify the position and mechanism of a Type IV endoleak.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Type IV Endoleak After Endovascular Aneurysm Repair Using Visualization With Novel Software

Nishi,

Kitahara,

Taguchi

et al. 2024

Cureus

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“…Nachdem Typ-IV-Endoleaks in der überwältigenden Mehrzahl der Fälle selbstlimitierend sind, stellt sich üblicherweise keine spezifische Behandlungsindikation [ 21 , 51 ]. Allerdings kann im Fall einer akuten Aortenruptur der persistierende Volumenverlust durch ein Typ-IV-Endoleak die hämodynamische Stabilität des Patienten signifikant beinträchtigen.…”

Section: Prävention Und Therapieunclassified

“…[21, 51]. Allerdings kann im Fall einer akuten Aortenruptur der persistierende Volumenverlust durch ein Typ-IV-Endoleak die hämodynamische Stabilität des Patienten signifikant beinträchtigen.…”

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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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“…Compared to T3EL, the stent graft in T4EL is intact. Chronic wear, deformation of the stent graft, and chronic exposure to the pulsatile forces might be possible mechanisms for T4EL 180 . 0.4-3% of patients developed T4EL after the aneurysm repair 147,151 , and it is far less frequent with the current generation of stent grafts.…”

Section: Type IV Endoleak (T4el)mentioning

confidence: 99%

Expression of circulating micro-RNAs in patients before and after AAA repair

Tan

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Abdominal aortic aneurysm (AAA) is the most common type of aortic aneurysm, which is defined as a dilation of the abdominal aorta over 3.0 cm or more. Surgical repair is the golden standard for the treatment of AAA, in which open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the main approaches. Technically speaking, the lesion segment of aueurysm is completely replaced by a graft during OSR, while in EVAR, the lesion is insulated by a stentgraft. EVAR is a less invasive treatment than OSR and shows a lower early mortality rate, although the long-term advantages of EVAR over OSR remain inconclusive. Endoleak, especially the type II endoleak (T2EL), is a common complication after EVAR. According to research, 16-28% of the patients develop a T2EL after EVAR, and it accounts for nearly three in four of all types of endoleaks. Around 30-50% of the T2EL resolved spontaneously during the follow-up, however, it still causes a secondary intervention in many patients. Therefore, it is critical to monitor endoleaks after repair. Patent aortic branches in the stent-overlapped area and vasa vasorum have been identified as potential sources of blood flow in T2EL. However, the mechanisms of biological changes or remodeling of the aneurysm sac after the repair are still not clear, but they have been considered to play an important role in the development of endoleaks. Unfortunately, it is impossible to obtain a tissue sample of the aortic wall in patients who underwent EVAR. MicroRNAs (miRNAs) are a class of small single-stranded non-coding RNAs that inhibit the expression of target message RNA (mRNA). miR-29b/29c, miR-155, and miR-15a are miRNAs associated with regulating extracellular matrix (ECM) components, inflammation, and proliferation, respectively. All four miRNAs have been identified as biomarkers of AAA, not only in aneurysm tissue but also extracellular as circulating miRNAs. However, it is still unknown whether they can reflect the biological changes after AAA repair. Thus, we conducted a prospective study to investigate the changes in expression of circulating miR-29b, miR-29c, miR-155, and miR-15a before (T0), 3 days (T1), and 3 months (T2) after AAA repair. A total of 39 patients were recruited for this study, 17 of whom were repaired by OSR and 22 of whom were repaired by EVAR. Four patients failed the T2 follow-up due to the Covid-19 pandemic. No significant changes were found in the expression of miR-29b, miR-29c, miR-155, and miR-15a. There were also no obvious differences between OSR and EVAR. However, the T1 expression of miR-15a was significantly lower in patients without endoleak after EVAR than in those who developed endoleak after EVAR and those who were repaired by OSR. Unfortunately, these differences did not persist to the T2 follow-up, and no other differences were found among these patients. In summary, miR-15a is a miRNA that significantly changes in AAA patients. This study demonstrates that the expression of circulating miR-15a is lower in patients without endoleak three days after EVAR, compared to those who had endoleak after EVAR and those who underwent OSR. The results suggest that miR-15a might be involved in the early aortic remodeling after EVAR as an indicator of endoleak.

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Late Sac Rupture due to a Type IV Endoleak after Previous Endovascular Aortic Aneurysm Repair: A Case Report

Cited by 6 publications

References 21 publications

Diagnosis of Type IV Endoleak After Endovascular Aneurysm Repair Using Visualization With Novel Software

Diagnosis of Type IV Endoleak After Endovascular Aneurysm Repair Using Visualization With Novel Software

Endovaskuläre Aortenreparatur bei Endoleaks

Expression of circulating micro-RNAs in patients before and after AAA repair

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