The Significance of Endoleaks in Thoracic Endovascular Aneurysm Repair

Results of the VALOR II trial of the Medtronic Valiant Thoracic Stent Graft

“…Bischoff et al 18 monitored 30 type II endoleaks after TEVAR (8.7% of their total population) and reported a 30% rate of intervention but that most of their endoleaks (7 of 9) originated from the left subclavian artery or celiac trunk where proximity to seal zones and large vessel size can cause these to behave like a type I endoleak. Alsac et al 19 reported a 19.4% endoleak rate with an average follow-up of 27 months, but only 29% of these were type II. They managed all of these conservatively, and 25% spontaneously thrombosed during follow-up.…”

Comparison of attachment site endoleak rates in Dacron versus native aorta landing zones after thoracic endovascular aortic repair

“…In these latter studies, the proportion of type I endoleaks detected #30 days ranged from 59% to 86%. 7,12,14,30,31 Most of the endoleaks noted in the first 30 days are likely the result of a missed endoleak present at the time of the index operation, potentially secondary to technical error, improper graft sizing due to inadequate preoperative case planning as might occur without the use of centerline CTA reconstruction, or inadequate intraoperative imaging, such as when a portable C-arm rather than fixed imaging such as in a hybrid operating room, is used. Late endoleaks (>6 months) are more likely the result of aortic remodeling.…”

“…3,4,[6][7][8][9][10][11] Established risk factors for type I endoleak include age, repair of fusiform aneurysms, long-segment aortic coverage, male sex, and large aneurysm size. [12][13][14][15] Although these risk factors cannot be modified, several authors have reported low endoleak rates when endografts are deployed with seal zones in previously replaced segments of Dacron aorta. [16][17][18] Placement of an endograft in a segment of replaced Dacron aorta may allow for reduced endoleak due to mechanical stability and decreased remodeling of the landing zone.…”

Endoleak and In-Stent Thrombus Detection with CT Angiography in a Thoracic Aortic Aneurysm Phantom at Different Tube Energies Using Filtered Back Projection and Iterative Algorithms

“…The phantom had an artificial spine insert and a shell made of soft-tissue-equivalent material mimicking the human thorax with respect to attenuation characteristics. volumetric data sets of isotropic voxels offer thin-section multiplanar reformatted images and enable accurate and reproducible volume and diameter measurement of the aneurysm sac (4)(5)(6)(7). However, because patients require multiple follow-up studies after EVAR, the high cumulative dose of ionizing radiation is of concern (8).…”