Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes

AbuRahma, Ali F.; Hass, Stephen M.; AbuRahma, Zachary; Yacoub, Michael; Mousa, Albeir Y.; Abu-Halimah, Shadi; Dean, Larry S.; Stone, Patrick A.

doi:10.1016/j.jamcollsurg.2016.12.014

Cited by 19 publications

(7 citation statements)

References 32 publications

(34 reference statements)

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“…The type 1a endoleak is a well established predictor for aneurysm expansion 5 , and in many cases re-intervention are needed to repair the type 1a endoleak 20 . The odd ratio for expansion of the aneurysm with a type 1a endoleak is 11.5, which was much larger than any other factors, therefore we excluded all seven type 1a endoleak in the following texture analysis.…”

Section: Resultsmentioning

confidence: 99%

CT texture analysis predicts abdominal aortic aneurysm post-endovascular aortic aneurysm repair progression

Ding

Hao

Wang

et al. 2020

Sci Rep

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The aim of this study is to investigate the role of early postoperative CT texture analysis in aneurysm progression. Ninety-nine patients who had undergone post-endovascular aneurysm repair (EVAR) infra-renal abdominal aortic aneurysm CT serial scans were enrolled from July 2014 to December 2019. The clinical and traditional imaging features were obtained. Aneurysm texture analysis was performed using three methods-the grey-level co-occurrence matrix (GLCM), the grey-level run length matrix (GLRLM), and the grey-level difference method (GLDM). A multilayer perceptron neural network was applied as a classifier, and receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) analysis were employed to illustrate the classification performance. No difference was found in the morphological and clinical features between the expansion (+) and (−) groups. GLCM yielded the best performance with an accuracy of 85.17% and an AUC of 0.90, followed by GLRLM with an accuracy of 87.23% and an AUC of 0.8615, and GLDM with an accuracy of 86.09% and an AUC of 0.8313. All three texture analyses showed superior predictive ability over clinical risk factors (accuracy: 69.41%; AUC: 0.6649), conventional imaging features (accuracy: 69.02%; AUC: 0.6747), and combined (accuracy: 75.29%; AUC: 0.7249). Early post-EVAR arterial phase-derived aneurysm texture analysis is a better predictor of later aneurysm expansion than clinical factors and traditional imaging evaluation combined. Abdominal aortic aneurysm (AAA) is a prevalent irreversible cardiovascular disease with a high mortality rate that needs immediate surgical intervention. Endovascular aortic aneurysm repair (EVAR) is the preferable choice for patients with AAA as a minimally invasive procedure, but intensive surveillance is recommended to detect possible postoperative aneurysm sac enlargement, the most recognised indicator of AAA rupture 1 , and for which secondary intervention is often performed to prevent deadly progression 2,3. Computed tomography (CT) is commonly used after EVAR for follow-up surveillance, and enhanced CT is usually performed as the first postoperative imaging modality to evaluate the outcome of EVAR surgery and make further individual treatment plans 1,4. Endoleak can easily be observed on postoperative CT and is detected in nearly 32% of AAAs 5. A classic sign of an endoleak is the observation of contrast agent overflow out of the stent-graft. Nevertheless, the long-term significance of the first noticed endoleak is debatable, transient endoleaks can be resolved spontaneously without medical intervention 6,7. Additionally, late-onset endoleaks are typically detected 6 months later after EVAR and are usually occult on the first CT scan 8,9. Thus, the detection of endoleaks on the first operative CT alone is limited to guide clinical decisions, and periodic imaging follow-up is still needed to monitor the evolution of AAA 10 , thus raising the medical expenditure, ionisation radiation, and potential harm to renal function.

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Section: Resultsmentioning

confidence: 99%

CT texture analysis predicts abdominal aortic aneurysm post-endovascular aortic aneurysm repair progression

Ding

Hao

Wang

et al. 2020

Sci Rep

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“…When type I endoleaks are identified at the time of the final aortography after EVAR, they are usually considered to justify treatment. 4 Type II endoleaks are mostly benign. However, in a few cases, they can cause enlargement of the sac and can eventually lead to rupture.…”

Section: Discussionmentioning

confidence: 99%

“…3 Endoleaks constitute the main cause of reinterventions. 4 It is often unclear which type of endoleak is the correct diagnose, 5 making the treatment decision difficult.…”

Section: Introductionmentioning

confidence: 99%

Use of carbon dioxide for therapeutic decision-making in endoleaks: a case report

et al. 2020

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Endovascular aneurysm repair is currently the most frequently treatment modality for infrarenal aortic aneurysms. Endoleaks are the most common cause of reintervention after endovascular aneurysm repair. It is often unclear which type of endoleak is the correct diagnose, making the treatment decision difficult. We report the case of a 72-year-old man with an endoleak two years after endovascular aneurysm repair. Images suggested a type III endoleak, but this was not confirmed by contrast aortography. We proceeded with the investigation using aortography with carbon dioxide and observed a type IA endoleak. This was successfully treated by implantation of a proximal cuff. A review of the literature shows that the role of carbon dioxide in endoleak management is still unclear. We present a case in which carbon dioxide was essential to both diagnosis and therapeutic decision-making in a type IA endoleak.

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“…Each procedure has a high technical success rate, ranging between 89.7% and 100%. AbuRahma et al [34] conducted a study in 71 cases of type Ia endoleak management with a Palmaz/Proximal cuff and found a technical success of 100%. Lu et al [35] found a high success rate in trials of embolization with fibrin glue in 42 cases.…”

Section: T1e Type I Endoleakmentioning

confidence: 99%

The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management

Yanamaladoddi¹,

Sarvepalli²,

Vemula³

et al. 2023

Cureus

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An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta above 3 cm or 50% greater than the segment above. It is a dangerous condition accounting for a substantial number of deaths per year and increasing at an alarming rate. Various factors come into play in the development of AAAs, which this study has elaborated on, including smoking and old age, demographics, and comorbid conditions. Endovascular aneurysm repair (EVAR) is a newer treatment modality used for AAAs in which an endograft device is placed into the aorta, thereby creating a bypass tract from the aneurysm and generating flow mimicking that of the natural aorta. It is minimally invasive and associated with less postoperative mortality and reduced hospital stay. However, EVAR is also associated with significant postoperative complications, including endoleaks, which were reviewed in depth. Endoleaks are postprocedural leaks into the aneurysm sac that are usually identified immediately after graft placement and indicate treatment failure. They are of five subtypes, categorized according to their mechanism of development. The most common type is type II endoleaks, and the most dangerous is type I endoleaks. Each subtype has multiple management options with varying rates of success. Prompt identification along with appropriate treatment of endoleaks can lead to better postoperative outcomes and improved quality of life for patients.

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Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes

Cited by 19 publications

References 32 publications

CT texture analysis predicts abdominal aortic aneurysm post-endovascular aortic aneurysm repair progression

CT texture analysis predicts abdominal aortic aneurysm post-endovascular aortic aneurysm repair progression

Use of carbon dioxide for therapeutic decision-making in endoleaks: a case report

The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management

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