The value of the initial post-EVAR computed tomography angiography scan in predicting future secondary procedures using the Powerlink stent graft

Patel, Mitul S.; Carpenter, Jeffrey P.

doi:10.1016/j.jvs.2010.06.019

Cited by 24 publications

(16 citation statements)

References 19 publications

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“…[ 16 19 20 ] There was also scholar suggested that because the majority of endoleaks requiring intervention have CTA-positive results or related symptoms in the early stage after surgery, CDFI could be used in follow-up if the CTA results do not show any abnormalities. [ 21 ] In our patients, the detection rate of endoleak by CEUS was higher than that by CDFI. There were two types of situations as follows: (1) There were no signals of blood flow by CDFI at the same sites that CEUS detected endoleak; and (2) when CEUS and CDFI detected endoleak, CEUS provided more information on endoleaks.…”

Section: Discussionmentioning

confidence: 60%

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Yang

Chen

Zhang

et al. 2015

Chinese Medical Journal

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Background:Endovascular aneurysm repair (EVAR) is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography (CTA), which is routine for follow-up, has side effects (e.g., radiation) and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound (CEUS) have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak.Methods:Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging (CDFI) and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDFI was conducted using Fisher's exact test and clinical outcomes of all patients were followed up.Results:Sixteen patients were enrolled, and 12 (75%) had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFI-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically different (P = 0.008). Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type III endoleak had open surgery when endovascular repair failed.Conclusions:CEUS is a new, safe, and effective means for detection of endoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

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Section: Discussionmentioning

confidence: 60%

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Yang

Chen

Zhang

et al. 2015

Chinese Medical Journal

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“…7,8,19 Other prior studies of Endologix endografts also did not identify endograft uncoupling or type III endoleaks over an extended follow-up period of 4 to 5 years. 20,21 AAA characteristics associated with late main-body modular EVAR uncoupling and type IIIa endoleak include large diameter or lengthy AAAs, difficult aortic neck anatomy (eg, short <15 mm or angulated >60 ), extreme AAA angulation or tortuosity, post-EVAR AAA shortening or lengthening in response to aneurysm sac remodeling; sideways displacement of the endograft producing angulation or "buckling" within the aneurysm sac, use of a samediameter aortic main body and proximal extension in the original Powerlink system, and most importantly, insufficient component overlap.…”

Section: Discussionmentioning

confidence: 82%

“…17,19 Until more data are forthcoming with respect to the revised IFU for the Endologix Powerlink and AFX platforms, the current study strongly suggests that patients treated under the old IFU before 2013 should be restudied annually by CT scan. Studies are now underway investigating post-EVAR surveillance with combined biplane abdominal X-ray and duplex ultrasound imaging to reduce long-term radiation and contrast exposure.…”

Section: Discussionmentioning

confidence: 92%

Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Skibba

Evans

Greenfield

et al. 2015

Journal of Vascular Surgery

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Although a small number of secondary interventions were needed after EVAR with the Endologix Powerlink or AFX endografts, most were undertaken for late main-body component uncoupling and type IIIa endoleak, which can occur after sideways displacement of the endograft in large and angulated AAAs. Patients treated before 2013 under the old instructions for use should be evaluated for signs of impending component separation and monitored annually, noting that expected indicators of endograft failure, such as increasing AAA diameter and endoleak, may be absent.

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“…To detect this difference with 90% power and a 0.05 significance level, 719 patients per group are required and 1438 in total. To correct for the fact that the first CTA of approximately 20% of patients is abnormal, 1798 patients (1438/0.8) are needed 20 21. In addition, we expect incomplete data in 10% of the patients which results in a total number of 1997 patients (1798/0.9).…”

Section: Methods and Analysismentioning

confidence: 99%

Postoperative surveillance and long-term outcome after endovascular aortic aneurysm repair in the Netherlands: study protocol for the retrospective ODYSSEUS study

et al. 2020

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IntroductionStrict imaging surveillance protocols to detect complications following endovascular aneurysm repair (EVAR) are common practice. However, controversy exists as to whether all EVAR patients need intense surveillance. The 2019 European Society for Vascular Surgery guidelines for management of abdominal aortic aneurysm (AAA) suggest that patients may be considered for limited follow-up with imaging if classified as ‘low risk’ for complications based on their initial postoperative imaging. The current study aims to investigate the intervention-free survival and overall survival stratified for patients with and without yearly imaging surveillance.Methods and analysisThe Observing a Decade of Yearly Standardised Surveillance in EVAR patients with Ultrasound or CT Scan study comprises a national multicentre retrospective cohort study in 17 medical centres. Consecutive patients with an asymptomatic or symptomatic infrarenal AAA who underwent EVAR between January 2007 and January 2012 will be included in this study with follow-up until December 2018. Clinical variables and all follow-up information will be retrieved in extensive data collection from the patient’s medical records. In addition, an e-survey was sent to vascular surgeons at the 17 participating centres to gauge their opinions regarding the possibility of safely reducing the frequency of imaging surveillance. Primary endpoints are intervention after EVAR and aneurysm-related mortality. The initial estimated sample size is 1997 patients.Ethics and disseminationThe study has been approved by the Medical Ethics Review Committee of the Amsterdam UMC, location Academic Medical Centre, Amsterdam, the Netherlands. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journal.Trial registration numberThe Netherlands Trial Registry, NL6953 (old: NTR28773).

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The value of the initial post-EVAR computed tomography angiography scan in predicting future secondary procedures using the Powerlink stent graft

Cited by 24 publications

References 19 publications

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Postoperative surveillance and long-term outcome after endovascular aortic aneurysm repair in the Netherlands: study protocol for the retrospective ODYSSEUS study

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