1
|
Almansour H, Mustafi M, Lescan M, Grosse U, Andic M, Schmehl J, Artzner C, Grözinger G, Walter SS. Golden-angle radial sparse parallel (GRASP) magnetic resonance angiography (MRA) for endoleak evaluation after endovascular repair of the aorta: a prospective comparison to conventional time-resolved MRA. Quant Imaging Med Surg 2024; 14:7420-7432. [PMID: 39429596 PMCID: PMC11485362 DOI: 10.21037/qims-24-1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 09/04/2024] [Indexed: 10/22/2024]
Abstract
Background Time-resolved angiography with interleaved stochastic trajectories (TWIST) magnetic resonance angiography (MRA) may obscure smaller vessels and is highly susceptibility to motion artifacts, potentially reducing endoleak detection accuracy after endovascular aortic repair (EVAR). The novel golden-angle radial sparse parallel (GRASP) sequence enhances spatial and temporal resolution with continuous, motion-robust datasets, showing promise for accurate endoleak detection post-EVAR. This study aimed to compare the diagnostic effectiveness of contrast-enhanced compressed-sensing radial GRASP-volume interpolated breath-hold examination (VIBE) sequence with standard contrast-enhanced dynamic TWIST-VIBE sequence in patients with inconclusive computed tomography angiography (CTA) findings regarding endoleak after EVAR. Methods This single-center prospective study consecutively enrolled adults with inconclusive findings regarding the presence or type of endoleak in multiphasic CTA following EVAR for abdominal aortic aneurysms. Participants underwent contrast-enhanced MRA, acquiring dynamic TWIST-VIBE and GRASP-VIBE sequences. Two independent radiologists assessed the datasets for image quality, diagnostic confidence, and the presence and type of endoleak. Additionally, quantitative assessments with signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were performed. Statistical analyses included interrater and intermethod agreement, and diagnostic performance testing. Results Twenty participants (mean age, 72±9 years; 13 males) were included. GRASP-VIBE demonstrated superior image quality over TWIST-VIBE sequence with predominantly absent motion artifacts and increased diagnostic confidence (all P<0.001). Diagnostic performance significantly improved for detecting type II endoleaks in GRASP-VIBE compared to TWIST-VIBE scans [area under the curve (AUC): 0.96 vs. 0.73; P=0.04]. Diagnostic accuracy improved with GRASP-VIBE for overall (AUC: 0.94 vs. 0.79) and endoleak type I detection (AUC: 1.0 vs. 0.90), however, not significantly (P≥0.05). TWIST-VIBE sequences demonstrated significantly higher SNR for measurements in the clotted aneurysm sac (P=0.01). No significant differences were observed in CNR for the aorta and any aneurysm sacs across the compared imaging sequences. Conclusions Compressed-sensing dynamic GRASP-VIBE sequence, with its superior image quality, diagnostic confidence, and performance, may be preferred over standard TWIST-VIBE sequence in inconclusive endoleak cases.
Collapse
Affiliation(s)
- Haidara Almansour
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Migdat Mustafi
- Klinik für Thoraxchirurgie-Lungentransplantation und Klinik für Kinderherzchirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Mario Lescan
- Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ulrich Grosse
- Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Mateja Andic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Jörg Schmehl
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
- Diakonie Klinikum Stuttgart, Department of Radiology, Stuttgart, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Sven S. Walter
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| |
Collapse
|
2
|
Chun JY, de Haan M, Maleux G, Osman A, Cannavale A, Morgan R. CIRSE Standards of Practice on Management of Endoleaks Following Endovascular Aneurysm Repair. Cardiovasc Intervent Radiol 2024; 47:161-176. [PMID: 38216742 PMCID: PMC10844414 DOI: 10.1007/s00270-023-03629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/19/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Endoleaks represent the most common complication after EVAR. Some types are associated with ongoing risk of aneurysm rupture and necessitate long-term surveillance and secondary interventions. PURPOSE This document, as with all CIRSE Standards of Practice documents, will recommend a reasonable approach to best practices of managing endoleaks. This will include imaging diagnosis, surveillance, indications for intervention, endovascular treatments and their outcomes. Our purpose is to provide recommendations based on up-to-date evidence, updating the guidelines previously published on this topic in 2013. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of clinicians with internationally recognised expertise in endoleak management. The writing group reviewed the existing literature performing a pragmatic evidence search using PubMed to select publications in English and relating to human subjects up to 2023. The final recommendations were formulated through consensus. RESULTS Endoleaks may compromise durability of the aortic repair, and long-term imaging surveillance is necessary for early detection and correct classification to guide potential re-intervention. The majority of endoleaks that require treatment can be managed using endovascular techniques. This Standards of Practice document provides up-to-date recommendations for the safe management of endoleaks.
Collapse
Affiliation(s)
- Joo-Young Chun
- St George's University Hospitals NHS Foundation Trust, London, UK.
- St George's University of London, London, UK.
| | - Michiel de Haan
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Asaad Osman
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Robert Morgan
- St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| |
Collapse
|
3
|
Yanamaladoddi VR, Sarvepalli SS, Vemula SL, Aramadaka S, Mannam R, Sankara Narayanan R, Bansal A. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management. Cureus 2023; 15:e39775. [PMID: 37398777 PMCID: PMC10312356 DOI: 10.7759/cureus.39775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | - Raam Mannam
- Research, Narayana Medical College, Nellore, IND
| | | | - Arpit Bansal
- Research, Narayana Medical College, Nellore, IND
| |
Collapse
|
4
|
De Guerre LEVM, O'Donnell TFX, Varkevisser RRB, Swerdlow NJ, Li C, Dansey K, van Herwaarden JA, Schermerhorn ML, Patel VI. The Association between Device Instructions for Use Adherence and Outcomes after Elective Endovascular Aortic Abdominal Aneurysm Repair. J Vasc Surg 2022; 76:690-698.e2. [PMID: 35276256 DOI: 10.1016/j.jvs.2022.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Aortic neck anatomy has a significant impact on the complexity of endovascular aortic aneurysm repair (EVAR), with concern that neck characteristics outside of instructions for use (IFU) may result in worse outcomes. Therefore, this study determined the impact of neck characteristics outside of IFU on perioperative and one-year outcomes and mid-term survival after EVAR. METHODS We identified all patients undergoing elective infrarenal EVAR from December 2014 to May 2020 in the Vascular Quality Initiative database. Neck characteristics outside of IFU were determined based the specific device IFU neck characteristics (Neck diameter, length, and angulation). Patients without one-year follow-up were excluded for the 1-year outcomes analyses (n=6,138 (40%)). We used multivariable adjusted logistic regression and Cox proportional hazard models to identify the independent associations between neck characteristics outside of IFU and our outcomes. RESULTS Of the 15,448 patients identified, 22.1% had neck characteristics outside of IFU, including 6.6% with a infrarenal angle, 6.8% with a neck length, 10.4% with a neck diameter, and 1.1% with a suprarenal angulation outside of IFU. Of these, 2.4% had more than one neck characteristic outside of IFU. Patients with neck characteristics outside of IFU were more often female (27.9% vs. 15.0%, P<.001) and were older (median age 75 vs. 73, P<.001). EVAR patients with neck characteristics outside of IFU had higher rates of type Ia endoleaks at completion (4.8% vs. 2.5%, P<.001), perioperative mortality (1.2% vs. 0.6%, P<.001), one-year sac expansion (7.1% vs. 5.3%, P=.017), and one-year reinterventions (4.4% vs. 3.2%, P=.03). In multivariable adjusted analyses, neck characteristics outside of IFU were independently associated with type Ia completion endoleaks (OR 1.6, [1.3-2.0], P<.001), perioperative mortality (OR 1.8; [1.2-2.7]; P=.005), one-year sac expansion (OR 1.4; [1.0-1.8]; P=.025) and one-year reinterventions (OR 1.4; [1.0-1.9]; P=.039). Unadjusted mid-term survival was lower for patients with neck characteristics outside of IFU than for patients without (5-year survival 84.0% vs. 86.7%, log-rank<.001). However, after adjustment, survival was similar for patients with neck characteristics outside of IFU to those within (HR: 1.1; [1.0-1.3]; P=.22). CONCLUSION Neck characteristics outside of IFU are independently associated with completion type Ia endoleaks, perioperative mortality, one-year sac expansion and one-year reinterventions among patients undergoing elective EVAR. These results indicate that continued effort is needed to improve the proximal seal in patients with neck characteristics outside of IFU undergoing EVAR. Also, in patients with severe hostile neck characteristics, alternative approaches such as open repair, use of a fenestrated or branched device, or endoanchors should be considered.
Collapse
Affiliation(s)
- Livia E V M De Guerre
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Thomas F X O'Donnell
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rens R B Varkevisser
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nicholas J Swerdlow
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Chun Li
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kirsten Dansey
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Marc L Schermerhorn
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Virendra I Patel
- Division of Vascular and Endovascular Surgery, New York Presbyterian/Columbia University Irving Medical Center/ Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032.
| |
Collapse
|
5
|
Van Slambrouck J, Mufty H, Maleux G, Houthoofd S, Devooght A, Slots C, Daenens K, Fourneau I. The impact of type 1a endoleak on the long-term outcome after EVAR. Acta Chir Belg 2021; 121:333-339. [PMID: 32644007 DOI: 10.1080/00015458.2020.1794337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Endoleaks remains a major determinant of outcome after endovascular aortic repair (EVAR) for infrarenal abdominal aortic aneurysms. The objective of this study is to evaluate the long-term impact of proximal type 1 endoleak encountered at the case end of the EVAR procedure or during follow-up. METHODS All patients treated with EVAR between February 2001 and August 2017 in our institution were included. Data were collected retrospectively. A descriptive analysis of subgroups with type 1a endoleak at case end or with type 1a endoleak first encountered during follow-up was performed. RESULTS In total, 468 patients were included for analysis. At the case end of the EVAR procedure, in 5.3% (25/468) of patients, a type 1a endoleak was seen. In 72% of cases (18/25) the type 1a endoleak spontaneously disappeared on the first follow-up computed tomography angiography and never recurred. At the end of the follow-up period, no patient in this subgroup died with a type 1a endoleak on follow-up. In 3.4% (16/468) of all cases, a type 1a endoleak was encountered for the first time during follow-up. In 87.5% (14/16) of these cases, reintervention was performed. Two patients died with a persisting type 1a endoleak during follow-up. CONCLUSIONS Clinicians should differentiate between the type 1a endoleak at the case end and the type 1a endoleak first occurring during follow-up. For type 1a endoleak at the case end, expectant management can be adopted. Delayed type 1a endoleak seen during follow-up rarely seals spontaneously and needs reintervention in the majority of cases.
Collapse
Affiliation(s)
- Jan Van Slambrouck
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anne Devooght
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Slots
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Perini P, Bianchini Massoni C, Mariani E, Ucci A, Fanelli M, Azzarone M, Freyrie A. Systematic Review and Meta-Analysis of the Outcome of Different Treatments for Type 1a Endoleak After EVAR. Ann Vasc Surg 2019; 60:435-446.e1. [DOI: 10.1016/j.avsg.2019.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
|
7
|
Gottardi R, Mudge T, Czerny M, Seitelberger R, Williams DF, Scherman J, Bezuidenhout D, Zilla P. A truly non-occlusive stent-graft moulding balloon for thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg 2019; 29:352-354. [DOI: 10.1093/icvts/ivz098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/23/2019] [Accepted: 03/08/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Endovascular treatment of thoracic aortic pathologies has recently progressed towards more proximal pathologies, including those of the aortic arch and ascending aorta where there is a higher risk for stent-graft migration during the deployment or the moulding procedure due to the beating and ejecting heart. Typical measures to prevent dislodgement of the balloon or the stent-graft during the procedure are rapid pacing or pharmacologically induced hypotension. We present a circular and fully non-occlusive stent-graft moulding balloon that does not require any reduction of cardiac output or hypotension during inflation, moulding and deflation of the balloon.
Collapse
Affiliation(s)
- Roman Gottardi
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Teddy Mudge
- Strait Access Technologies, Cape Town, South Africa
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Rainald Seitelberger
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - David F Williams
- Strait Access Technologies, Cape Town, South Africa
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, NC, USA
| | - Jacques Scherman
- Chris Barnard Department of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Deon Bezuidenhout
- Strait Access Technologies, Cape Town, South Africa
- Chris Barnard Department of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Peter Zilla
- Strait Access Technologies, Cape Town, South Africa
- Chris Barnard Department of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
8
|
Spontaneous Type Ia Endoleak Sealing in Patients Undergoing Endovascular Aneurysm Repair With the Ovation Stent Graft. Ann Vasc Surg 2019; 54:240-247. [DOI: 10.1016/j.avsg.2018.04.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/20/2022]
|
9
|
Swerdlow NJ, McCallum JC, Liang P, Li C, O'Donnell TFX, Varkevisser RRB, Schermerhorn ML. Select type I and type III endoleaks at the completion of fenestrated endovascular aneurysm repair resolve spontaneously. J Vasc Surg 2018; 70:381-390. [PMID: 30583892 DOI: 10.1016/j.jvs.2018.09.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The Society for Vascular Surgery reporting standards for endovascular aneurysm repair (EVAR) consider the presence of a type I or type III endoleak a technical failure. However, the nature and implications of these endoleaks in fenestrated EVAR (FEVAR) are not well understood. METHODS We performed a single-center retrospective review of 53 patients who underwent FEVAR with the Zenith Fenestrated AAA Endovascular Graft (Cook Medical, Bloomington, Ind) from 2013 to 2018. We excluded one patient without contrast-enhanced postoperative imaging who was lost to follow-up after discharge. Small, slow, type I and type III endoleaks on completion angiography were routinely observed. We identified patients with completion type I or type III endoleaks by angiography review and characterized endoleak type, location, and rate of resolution on initial postoperative imaging. RESULTS Fifty-two patients were included; mean age was 75 ± 8 years, 75% were male, and 91% were white. Of 146 visceral vessels (100 renal arteries and 46 superior mesenteric arteries), 145 (99%) were preserved with 103 fenestrations and 43 scallops; 102 (70%) target vessels were stented. After implantation of all device components, 31 patients (60%) had evidence of type I or type III endoleak. Twelve patients (39%) underwent further intervention at the index procedure, and three endoleaks resolved completely. Twenty-eight patients (54%) had a type I or type III endoleak on completion angiography. There were no differences between patients with and without completion endoleaks in baseline demographics, graft design, neck anatomy, or proportion of cases performed within the instructions for use of the device. Perioperative mortality was 1.9%. On initial postoperative imaging, 27 of 28 (96%) endoleaks resolved spontaneously. One small, persistent type IA or type III endoleak was identified on postoperative day 27 and was observed. This endoleak had resolved completely on computed tomography angiography 6 months postoperatively. In patients without a completion endoleak, one type IA endoleak secondary to graft infolding was discovered on postoperative imaging and was successfully treated with placement of endoanchors and Palmaz stent. Median follow-up was 269 days. No additional type I or type III endoleaks were identified in any patient for the duration of follow-up. CONCLUSIONS Whereas completion type I and type III endoleaks are common after FEVAR with the ZFEN device, nearly all of these endoleaks resolve spontaneously by the initial postoperative imaging. These results suggest that select completion endoleaks after FEVAR with the ZFEN device do not require intervention at the index procedure.
Collapse
Affiliation(s)
- Nicholas J Swerdlow
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - John C McCallum
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Chun Li
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Thomas F X O'Donnell
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Rens R B Varkevisser
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
| |
Collapse
|
10
|
Qazi AA, Jaberi A, Mironov O, Addas J, Qazi E, Tarulli E, Simons M, Tan KT. Conservative management of type 1A endoleaks at completion angiogram in endovascular repair of infra-renal abdominal aortic aneurysms with current generation stent grafts. Vascular 2018; 27:168-174. [DOI: 10.1177/1708538118811206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Proximal type 1A endoleaks on completion intra-operative angiography are not infrequently seen following endovascular abdominal aneurysm repair (EVAR). The natural course of these leaks is not well established. We sought to determine the rate of spontaneous resolution and a conservative treatment approach to these endoleaks. Methods All cases involving endovascular repairs of infra-renal abdominal aortic aneurysms resulting in proximal type 1A endoleak on final intra-operative completion angiography were retrospectively reviewed from 1 April 2010 and 30 March 2015. Demographic, pre and post-procedural imaging, and clinical outcomes were reviewed. Summarizing descriptive statistics are reported. Results Of the 337 patients who underwent an EVAR, 24 patients (7.1%) had a proximal type 1A endoleak on final intra-operative angiography. Twenty-two of 24 patients (92%) with proximal type 1A endoleaks had spontaneous resolution on follow-up imaging without any intervention, while two (8%) patients had a persistent endoleak. One of these patients required intervention. The median follow-up for patients with resolved endoleaks was 2.5 years vs. 4 and 6 years, respectively, for patients that did not resolve spontaneously. Conclusion A conservative approach may be used in the management of patients with proximal type 1A endoleaks on completion angiography once maximum proximal seal was achieved intra-operatively as the vast majority of these leaks spontaneously seal.
Collapse
Affiliation(s)
- Abdul Aziz Qazi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Arash Jaberi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Oleg Mironov
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Jamil Addas
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Emmad Qazi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Emidio Tarulli
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Martin Simons
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Select early type IA endoleaks after endovascular aneurysm repair will resolve without secondary intervention. J Vasc Surg 2018; 67:119-125. [DOI: 10.1016/j.jvs.2017.05.096] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 11/21/2022]
|
12
|
Zhou M, Su Z, Shi Z, Fu W, Meng X, Wang Y, Guo B, Huang K. Application of color-coded quantitative digital subtraction angiography in predicting the outcomes of immediate type I and type III endoleaks. J Vasc Surg 2017; 66:760-767. [DOI: 10.1016/j.jvs.2016.11.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
|
13
|
AbuRahma AF, Hass SM, AbuRahma ZT, Yacoub M, Mousa AY, Abu-Halimah S, Dean LS, Stone PA. Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes. J Am Coll Surg 2016; 224:740-748. [PMID: 28017805 DOI: 10.1016/j.jamcollsurg.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks. STUDY DESIGN This was a retrospective review of prospectively collected data from EVAR patients during a 10-year period. All post-EVAR type Ia endoleaks on completion angiogram were identified (group A) and their early (30-day) and late outcomes were compared with outcomes of patients without endoleaks (group B). Kaplan-Meier analysis was used for survival analysis, sac expansion, late type Ia endoleak, and reintervention. RESULTS Seventy-one of 565 (12.6%) patients had immediate post-EVAR type Ia endoleak. Early intervention (proximal aortic cuffs and/or stenting) was used in 56 of 71 (79%) in group A vs 31 of 494 (6%) in group B (p < 0.0001). Late type Ia endoleak was noted in 9 patients (13%) in group A at a mean follow-up of 28 months vs 10 patients (2%) in group B at a mean follow-up of 32 months (p < 0.0001). Late sac expansion and reintervention rates were 9% and 10% for group A vs 5% and 3% for group B (p = 0.2698 and p = 0.0198), respectively. Freedom rates from late type Ia endoleaks at 1, 3, and 5 years for group A were 88%, 85%, and 80% vs 98%, 98%, and 96% for group B (p < 0.001); and for late intervention, were 94%, 92%, and 77% for group A, and 99%, 97%, and 95% for group B (p = 0.007), respectively. Survival rates were similar. CONCLUSIONS Immediate post-EVAR type Ia endoleaks are associated with higher rates of early interventions, late endoleaks and reintervention, which will necessitate strict post-EVAR surveillance.
Collapse
Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, WV.
| | - Stephen M Hass
- Department of Surgery, West Virginia University, Charleston, WV
| | | | - Michael Yacoub
- Department of Surgery, West Virginia University, Charleston, WV
| | - Albeir Y Mousa
- Department of Surgery, West Virginia University, Charleston, WV
| | | | - L Scott Dean
- CAMC Health Education and Research Institute, Charleston, WV
| | - Patrick A Stone
- Department of Surgery, West Virginia University, Charleston, WV
| |
Collapse
|
14
|
Tan TW, Eslami M, Rybin D, Doros G, Zhang WW, Farber A. Outcomes of patients with type I endoleak at completion of endovascular abdominal aneurysm repair. J Vasc Surg 2016; 63:1420-7. [DOI: 10.1016/j.jvs.2016.01.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/16/2016] [Indexed: 01/15/2023]
|
15
|
Pranteda C, Sirignano P, Capoccia L, Mansour W, Montelione N, Speziale F. Spontaneous Sealing of a Type Ia Endoleak after Ovation Stent Graft Implantation in a Patient with On-Label Aortic Neck Anatomy. Ann Vasc Surg 2016; 34:270.e19-24. [PMID: 27174349 DOI: 10.1016/j.avsg.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 10/21/2022]
Abstract
We report a case of an early type Ia endoleak after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm by Ovation Stent Graft implantation and spontaneously resolved without further reintervention. The patient presents a conical aortic neck, but EVAR was performed within the instruction for use proposed by manufactory. At completion angiography, a low-flow type Ia endoleak was present and left untreated. Computed tomographic angiography performed on the third postoperative day showed infolding of the 2 sealing rings. The patient was dismissed without further treatment. At 3-month follow-up, the leak appeared spontaneously sealed with partial expansion of the 2 rings.
Collapse
Affiliation(s)
- Chiara Pranteda
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Nunzio Montelione
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
16
|
Abstract
Hydrogel-coated coils are truly detachable coils with a platinum core covered with hydrogel. The coils are available in 0.018- and 0.035-in systems. These coils have the ability to expand up to four times their size ∼20 minutes after deployment, thus providing a very effective mechanical vascular occlusion effect. The vessel-occlusive effect of these coils is a volume, space-occupying effect, not a thrombotic effect, as seen in fibered coils. Hydrogel-coated coils were originally developed and designed to treat brain aneurysms; however, their use has expanded to peripheral applications. Hydrogel-coated coils have been used in the management of visceral aneurysms, high-flow vascular arteriovenous fistulae, and endoleaks after endovascular thoracic and abdominal aneurysm repair. The purpose of this article is to describe the hydrogel-coated coil system, the mechanism of action, technical details for optimal deployment, and clinical applications.
Collapse
Affiliation(s)
- Hector Ferral
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, Illinois
| |
Collapse
|
17
|
Outcomes of persistent intraoperative type Ia endoleak after standard endovascular aneurysm repair. J Vasc Surg 2015; 61:1185-91. [DOI: 10.1016/j.jvs.2014.12.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
|
18
|
Ioannou CV, Kontopodis N, Georgakarakos E, Dalainas I. Commentary: transcaval approach in the management of a type I endoleak associated with the ovation stent-graft system. J Endovasc Ther 2015; 22:431-5. [PMID: 25900724 DOI: 10.1177/1526602815583821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Efstratios Georgakarakos
- Vascular Surgery Unit, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ilias Dalainas
- Vascular Surgery Department, University of Athens, Athens, Greece
| |
Collapse
|