Comparison of computed tomography and duplex imaging in assessing aortic morphology following endovascular aneurysm repair

1998 ◽  
Vol 85 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Thompson ◽  
Boyle ◽  
Hartshorn ◽  
Maltezos ◽  
Nasim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Aneurysm Repair ◽  
Duplex Imaging ◽  
Aneurysm Repair ◽  
Aortic Morphology

scholarly journals Time-Enhancement Curve of Four-Dimensional Computed Tomography Predicts Aneurysm Enlargement with Type-II Endoleak after Endovascular Aneurysm Repair

Aorta ◽  
2020 ◽  
Vol 08 (02) ◽  
pp. 029-034
Author(s):  
Yunosuke Nishihara ◽  
Kota Mitsui ◽  
Shinya Azama ◽  
Daisuke Okamoto ◽  
Manabu Sato ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Equilibrium Phase ◽  
Endovascular Aneurysm Repair ◽  
Three Dimensional ◽  
Type Ii ◽  
Ct Scanner ◽  
Stable Group ◽  
Ct Number ◽  
4D Ct ◽  
Aneurysm Repair

Abstract Objective We investigated the hemodynamic features of Type-II endoleaks after endovascular aneurysm repair (EVAR) using four-dimensional (4D) computed tomography (CT) to identify patients with aneurysm enlargement. Methods During a 13-month period (January 2017–January 2018) at our institution, we performed 4D-CT examinations in 13 patients after EVAR because of suspected Type-II endoleaks. Three patients were excluded from the study because of other endoleaks or absence of detectable endoleaks. The ramaining 10 patients were divided into two groups: enlargement group (n = 4), in which the aneurysm volume increased, and stable group (n = 6), in which the aneurysm remained stable or shrank. A CT scanner and three-dimensional workstation were used. All images were obtained using a consistent protocol (22 phase scans using the test bolus tracking method). We analyzed the hemodynamics of the endoleak cavity (EC) relative to those of the aorta and evaluated the time-enhancement curves (TECs) using measurement protocols. The strengths of correlations between these factors in the two groups were analyzed statistically. Results TECs in the enlargement group showed a more gradual curve, and the upslope, the gradient of TEC in the ascending phase and the upslope index were significantly more gradual than those in the stable group (p = 0.0247, 0.0243). The EC washout and the EC washout index were also more gradual than in the stable group's (p = 0.019, 0.019). The enhancement duration was longer in the former than in the latter (80%, p = 0.0195; 70%, p = 0.0159; 60%, p = 0.0159). The CT number in the equilibrium phase was larger in the enlargement group than in the stable group (p = 0.019). Conclusion The 4D-CT is useful for predicting aneurysm enlargement with Type-II endoleaks after EVAR.

scholarly journals U-Shape Kissing Chimney Thoracic Endovascular Aneurysm Repair for a Traumatic Arch Rupture in a Polytraumatized Patient

Aorta ◽  
2015 ◽  
Vol 03 (01) ◽  
pp. 41-45 ◽  
Author(s):  
Jeroen Hendriks ◽  
Tim Brits ◽  
Thijs Van der Zijden ◽  
Koen Monsieurs ◽  
Dina de Bock ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Endovascular Aneurysm Repair ◽  
High Impact ◽  
Computed Tomography Scan ◽  
Polytraumatized Patient ◽  
Subarachnoid Bleeding ◽  
Thoracic Endovascular Aneurysm Repair ◽  
Aneurysm Repair ◽  
Tomography Scan

AbstractAn 18-year-old male patient was admitted to our hospital because of a high impact trauma. A computed tomography scan showed massive mediastinal bleeding due to a posteriorly located rupture of the aortic arch with formation of a pseudoaneurysm. Although urgent repair was indicated, open cardiac surgery was not feasible, as this would involve full heparinization in a patient with subarachnoid bleeding. The chosen solution was to perform a percutaneous thoracic endovascular aneurysm repair (TEVAR) and a kissing chimney procedure using a U-shape configuration.

Evolution and clinical relevance of common iliac artery seal zone after endovascular aortic aneurysm repair

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 363-368 ◽  
Author(s):  
Gergana T Taneva ◽  
Alejandro González García ◽  
Ana Begoña Arribas Díaz ◽  
Yasmina Baquero Yebra ◽  
Konstantinos P Donas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Iliac Artery ◽  
Computed Tomography Angiography ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Iliac Arteries ◽  
Radiological Data ◽  
The Mean ◽  
Aneurysm Repair

Objective Data in literature suggest iliac artery dilatation and endograft retraction as complications after endovascular aneurysm repair. However, mainly older generation endografts were included. Therefore, we sought to evaluate the distal sealing zone chronological changes after endovascular aneurysm repair with newer generation stent-grafts. Methods Clinical and radiological data of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair between January 2010 and December 2013 were reviewed. Measurements were made using volumetric reconstructions in the first and last available computed tomography angiography. Endpoints of the study were the presence of iliac dilatation and retraction of the endograft. Association with distal oversizing and sealing length was analyzed. Results Consecutive patients with a total of 52 common iliac arteries were included in the study (mean age 74.9 ± 6.8 years, four women (7.7%)). The mean follow-up was 3.1 years. The mean iliac diameter increased from 15.5 to 17.1 mm ( p < .001) in the first control computed tomography angiography and to 18.7 mm ( p < .001) in the last available computed tomography angiography. No endograft (Endurant by Medtronic (24/52; 46%), Excluder de Gore (23/52; 44%), Zenith by Cook (5/52; 9%)) was associated with dilatation ( p = .066) or iliac retraction ( p = .591). Two type Ib endoleaks were found (3.8%) and successfully treated with distal graft extension. An iliac branch retraction of ≥5 mm was identified in seven cases (13%). Iliac arteries treated with limbs of ≥24 mm in diameter dilated significantly more than the rest of limbs (5.37 mm versus 3.12 mm; p = .022). In the last available imaging, iliac dilatation was ≥20% in 28 cases (53.8%) and had exceeded the diameter of the implanted endograft in 20 cases (38.4%). Iliac dilatation (OR 15.11 per mm, p = .025) was identified as a risk factor for retraction ≥5 mm. Conclusion Iliac dilatation and endograft limb retraction are common findings after endovascular aneurysm repair despite the use of new generation endografts. Optimizing the iliac sealing length and meticulous computed tomography angiography surveillance are recommended especially in case of use ≥24 mm iliac stent-grafts to prevent possible complications.

In Vitro Quantification of Gutter Formation and Chimney Graft Compression in Chimney EVAR Stent-Graft Configurations Using Electrocardiography-Gated Computed Tomography

2018 ◽  
Vol 25 (3) ◽  
pp. 387-394 ◽  
Author(s):  
Simon P. Overeem ◽  
Esmé J. Donselaar ◽  
Jorrit T. Boersen ◽  
Erik Groot Jebbink ◽  
Cornelis H. Slump ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Stent Graft ◽  
Cardiac Cycle ◽  
Intraclass Correlation ◽  
Endovascular Aneurysm Repair ◽  
Enhanced Computed Tomography ◽  
Geometric Changes ◽  
Aneurysm Repair ◽  
Chimney Graft

Purpose: To assess the dynamic behavior of chimney grafts during the cardiac cycle. Methods: Three chimney endovascular aneurysm repair (EVAR) stent-graft configurations (Endurant and Advanta V12, Endurant and Viabahn, and Endurant and BeGraft) were placed in silicone aneurysm models and subjected to physiologic flow. Electrocardiography (ECG)-gated contrast-enhanced computed tomography was used to visualize geometric changes during the cardiac cycle. Endograft and chimney graft surface, gutter volume, chimney graft angulation over the center lumen line, and the D-ratio (the ratio between the lengths of the major and minor axes) were independently assessed by 2 observers at 10 time points in the cardiac cycle. Results: Both gutter volumes and chimney graft geometry changed significantly during the cardiac cycle in all 3 configurations (p<0.001). Gutters and endoleaks were observed in all configurations. The largest gutter volume (232.8 mm3) and change in volume (20.7 mm3) between systole and diastole were observed in the Endurant-Advanta configuration. These values were 2.7- and 3.0-fold higher, respectively, compared to the Endurant-Viabahn configuration and 1.7- and 1.6-fold higher as observed in the Endurant-BeGraft configuration. The Endurant-Viabahn configuration had the highest D-ratio (right, 1.26–1.35; left, 1.33–1.48), while the Endurant-BeGraft configuration had the lowest (right, 1.11–1.17; left, 1.08–1.15). Assessment of the interobserver variability showed a high correlation (intraclass correlation >0.935) between measurements. Conclusion: Gutter volumes and stent compression are dynamic phenomena that reshape during the cardiac cycle. Compelling differences were observed during the cardiac cycle in all configurations, with the self-expanding (Endurant–Viabahn) chimney EVAR configurations having smaller gutters and less variation in gutter volume during the cardiac cycle yet more stent compression without affecting the chimney graft surface.

scholarly journals Adequate seal and no endoleak on the first postoperative computed tomography angiography as criteria for no additional imaging up to 5 years after endovascular aneurysm repair

2013 ◽  
Vol 57 (6) ◽  
pp. 1503-1511 ◽  
Author(s):  
Frederico Bastos Gonçalves ◽  
Koen M. van de Luijtgaarden ◽  
Sanne E. Hoeks ◽  
Johanna M. Hendriks ◽  
Sander ten Raa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Endovascular Aneurysm Repair ◽  
Additional Imaging ◽  
Aneurysm Repair

Commentary: Preoperative Aortic Morphology Identifies Patients at High Risk for Late Failure of Endovascular Aneurysm Repair

2017 ◽  
Vol 24 (3) ◽  
pp. 418-420
Author(s):  
Nikolaos Kontopodis ◽  
Nikolaos Galanakis ◽  
Dimitrios Tsetis ◽  
Christos V. Ioannou
Keyword(s):  
High Risk ◽  
Endovascular Aneurysm Repair ◽  
Late Failure ◽  
Aneurysm Repair ◽  
Aortic Morphology

Translumbar Embolization of Type II Endoleaks: 12 Years of Experience at a Regional Vascular Centre

2020 ◽  
Vol 54 (5) ◽  
pp. 389-394 ◽  
Author(s):  
Wiliam Rhodri Thomas ◽  
Salil Karkhanis ◽  
Jonathan Hopkins ◽  
Martin Duddy
Keyword(s):  
Computed Tomography ◽  
Psoas Abscess ◽  
Endovascular Aneurysm Repair ◽  
Major Complication ◽  
Type Ii ◽  
Technical Success Rate ◽  
Feeding Vessels ◽  
Major Complication Rate ◽  
Aneurysm Repair

Background and Aims: The management of persistent type II endoleaks (T2E) is often problematic for the endovascular specialist, with a lack of clear evidence for the best approach for embolization. The aim of this study was to evaluate the safety and efficacy of translumbar embolization (TLE) for T2E following endovascular aneurysm repair (EVAR). Methods: This retrospective review included 27 embolizations performed on 23 patients with a median age of 78 (range 67-94 years; male: female 15:9), during the period September 2006 to July 2018. Primary outcome was freedom from aneurysm sac growth defined as <2 mm sac diameter increase on subsequent computed tomography. Results: The initial technical success rate was 100%, with complete “on table” embolization of the T2E on fluoroscopy; however, 4 (15%) patients needed repeat TLE due to persistent endoleak identified on follow-up computed tomography or because of further sac expansion. Satisfactory stasis was achieved in these 4 cases following a second embolization. The mean volume of embolic injected was 7.4 mL per case. Feeding vessels were identified on angiography in all cases; the nidus was supplied by lumbar branches in 21 cases, by the inferior mesenteric artery in 1 case and by both in a further 5 cases. Freedom from aneurysm sac growth (defined as < 2 mm) following 1 or 2 separate TLE was achieved in 18 (78%) and 20 (86%) patients, respectively. The major complication rate was <5% with one case of psoas abscess presenting 7 months following embolization; there were 2 minor complications in the form of intraprocedural transient abdominal pain. Conclusion: The translumbar approach is a safe and effective technique to treat T2E, as evidenced by the low complication and reintervention rate.

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