Type-II Endoleaks following Endovascular AAA Repair: Preoperative Predictors and Long-term Effects

2001 ◽  
Vol 8 (5) ◽  
pp. 503-510 ◽  
Author(s):  
Frank R. Arko ◽  
Geoffrey D. Rubin ◽  
Bonnie L. Johnson ◽  
Bradley B. Hill ◽  
Thomas J. Fogarty ◽  
...  
Keyword(s):  
Computed Tomographic Angiography ◽  
Aortic Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Long Term Effects ◽  
Computed Tomographic ◽  
Duplex Imaging ◽  
Preoperative Ct ◽  
Tomographic Angiography

Purpose: To determine the significance of persistent type-II endoleaks and whether they can be predicted preoperatively in patients with abdominal aortic aneurysms (AAA). Methods: The charts of all AAA patients treated with the AneuRx stent-graft at a single center from 1996 to 1998 were reviewed. Patients with <12-month follow-up or type-I endoleaks were excluded. The presence or absence of type-II endoleaks was determined from duplex imaging and computed tomographic angiography. Three groups were identified and compared: 16 patients with persistent type-II endoleaks (PE), 14 patients with transient type-II endoleaks (TE), and 16 patients with no endoleak (NE). Results: The groups did not differ with regard to age, preoperative comorbidities, follow-up time, and AAA neck diameter and length. AAA diameters were 57.1 ± 9.0 mm for NE, 63.4 ± 11.4 mm for TE, and 55.6 ± 4.2 mm for PE. The inferior mesenteric artery (IMA) was patent in 5 (31%) NE patients, 6 (43%) TE patients, and 13 (81%) PE patients (p < 0.01). The number of patent lumbar arteries visualized preoperatively was 0.5 ± 1.0 in NE, 1.3 ± 0.8 in TE, and 2.4 ± 0.6 in PE (p < 0.0001). Patent IMAs (RR 0.82, p<0.01) and >2 lumbar arteries (RR 0.40, p < 0.0001) were identified as independent preoperative risk factors for persistent endoleaks. There were no changes in mean diameter or volume in aneurysms with persistent endoleaks. Conclusions: No adverse clinical events were related to the presence of type-II endoleaks, but there was no decrease in aneurysm size in patients with persistent type-II leaks. Patients with a large, patent IMA, or >2 lumbar arteries on preoperative CT angiography are at higher risk for persistent type-II endoleaks.

Early Computed Tomographic Angiography after Endovascular Aneurysm Repair: Worthwhile or Worthless?

Vascular ◽  
2008 ◽  
Vol 16 (5) ◽  
pp. 253-257 ◽  
Author(s):  
Evert J. Waasdorp ◽  
Joost A. van Herwaarden ◽  
Rob H.W. van de Mortel ◽  
Frans L. Moll ◽  
Jean-Paul P.M. de Vries
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Computed Tomographic Angiography ◽  
Type I ◽  
Type Ii ◽  
Graft Thrombosis ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Aneurysm Repair

This study evaluated the value of computed tomographic angiography (CTA) early after an endovascular aneurysm repair (EVAR) in relation to CTA 3 months after EVAR. We retrospectively reviewed all elective EVAR patients with available postprocedural and 3-month follow-up CTAs who were treated between 1996 and 2006. CTAs were analyzed for EVAR-related complications in terms of endoleaks, migration, and stent graft thrombosis. Secondary procedures and other complications within a 4-month time interval after EVAR were noted and analyzed for any association with the postprocedural CTA. During the study period, 291 patients (275 men), with a mean age of 71 years, underwent elective EVAR. All had postprocedural and 3-month follow-up CTAs, which detected 93 (32%) endoleaks (8 type I, 84 type II, 1 type III) and 1 stent graft thrombosis. These findings resulted in four secondary interventions (one interposition cuff, two extension cuffs, one conversion). All reinterventions were successfully done in an elective setting. During the first 3 postoperative months, five other reinterventions were required for acute ischemia in four patients (three Fogarty procedures, one femorofemoral crossover bypass) or groin infection in one patient. Eight patients died, but none of the deaths were related to abdominal aortic aneurysm or EVAR (four cardiac, two pulmonary, one gastric bleeding, one carcinoma). At 3 months, 43 endoleaks (3 type I, 40 type II), 3 stent graft thromboses, and 1 stent graft migration were seen. In two patients (0.7%), a new endoleak was diagnosed compared with the postprocedural CTAs. In 287 (99%) of 291 patients, the postprocedural CTA did not influence our treatment policy in the first 3 months after EVAR. More than half of the early endoleaks were self-limiting, and new endoleaks were seen in only two patients (< 1%) at the 3-month follow-up CTA. After an uneventful EVAR procedure, it is safe to leave out the early postprocedural CTA.

Stent-Graft Treatment of Penetrating Thoracic Aortic Ulcers

2002 ◽  
Vol 9 (2_suppl) ◽  
pp. II-25-II-31 ◽  
Author(s):  
Xavier Kos ◽  
Louis Bouchard ◽  
Philippe Otal ◽  
Valérie Chabbert ◽  
Patricia Chemla ◽  
...  
Keyword(s):  
Stent Graft ◽  
Treatment Options ◽  
Neurological Complication ◽  
Computed Tomographic Angiography ◽  
Aortic Diameter ◽  
Type I ◽  
Type Ii ◽  
Computed Tomographic ◽  
Clinical Complications

Purpose: To evaluate the efficacy of stent-graft placement for the treatment of penetrating thoracic aortic ulcers. Methods: Ten patients (7 men; mean age 73.8 years, range 69–79) were treated for penetrating thoracic aortic ulcers using Talent or Excluder stent-grafts. Preoperative examinations included computed tomographic angiography (CTA), transesophageal echography, and digital subtraction angiography (DSA). Follow-up included predischarge multimodal imaging and periodic CTA scans after discharge. Endoleaks, aortic diameter changes, and clinical complications were tracked. Results: Technical success was achieved in 100%, but 1 major neurological complication led to death 3 months after the procedure. Radiological follow-up detected 4 early endoleaks (3 type I and a type II), all of which spontaneously regressed, and 1 secondary type II endoleak. The mean aortic diameter decreased by 22% over a mean 9-month follow-up. Conclusions: Aortic ulcers are potentially lethal lesions. Considering its low morbidity and mortality, endovascular repair could widen the treatment options for these lesions.

scholarly journals Management of a spontaneous supra-aortic arterial dissection: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Omar M. Sharaf ◽  
Tomas D. Martin ◽  
Eric I. Jeng
Keyword(s):  
Innominate Artery ◽  
Operative Management ◽  
Computed Tomographic Angiography ◽  
Artery Dissection ◽  
Term Therapy ◽  
Type I ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Aortic Dissections ◽  
Isolated Innominate Artery

Abstract Background Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. Case presentation A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management—anti-impulse regimen, antiplatelet therapy, and close follow-up. Conclusions Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.

scholarly journals Imaging Follow-up after Carotid Artery Stenting with Carotid Wallstent Using Computed Tomographic Angiography

2017 ◽  
Vol 45 (1) ◽  
pp. 7-13
Author(s):  
Tatsufumi NOMURA ◽  
Daisuke SASAMORI ◽  
Tadashi NONAKA ◽  
Akira TAKAHASHI ◽  
Yasuyuki YONEMASU ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Carotid Wallstent

P6149Coronary computed tomographic angiography (CTA) for risk stratification in the diagnostic triage of patients undergoing liver transplantation (LT): A long-term outcome study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Strobl ◽  
T Senoner ◽  
A Finkenstedt ◽  
G Widmann ◽  
F Plank ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Calcium Score ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Computed Tomographic ◽  
All Cause Mortality ◽  
Stenosis Severity ◽  
Tomographic Angiography

Abstract Background Cardiovascular (CV) risk stratification in patients with end-stage liver disease (ESLD) prior to liver transplantation (LT) is crucial: CV-disease poses a major threat for posttransplant survival. Therefore, our purpose was to assess safety of coronary computed tomographic angiography (CTA) in patients prior to orthotopic LT over a long-term follow up period, and its value for CV risk stratification. Methods In this single center, retrospective observational study 458 patients underwent coronary calcium score (CCS) and coronary CTA for pre-LT risk stratification between 2005 and 2016. CTA was evaluated for 1) stenosis severity (CADRADS: 4-severe>70%/3-intermediate50–70%/2-mild<50%/1-minimal<25%/0=no CAD) 2) plaque burden (SIS, G-score), 3) high–risk plaque features (Napkin Ring Sign, low attenuation plaque, positive remodelling) and 4) Coronary Calcium Score. Primary endpoint was mortality (all-cause and cardiovascular), secondary endpoint major cardiovascular events (MACE). Results Finally 270 patients (79.3% males, age 61±8.5 years) who underwent orthotopic LT were included (mean follow-up 7.5 years±3.1, range 2–13). 87 (32.2%) had CCS zero and 60 (22.2%) CCS >300 Agatston Units (CCS 335.6 AU± 868.9). 248 patients underwent CTA after CCS. The majority had CAD (n=173, 72.3%) by CTA while only 75 (27.7%) had no CAD. 102 patients (38.8%) had minimal-or-mild stenosis<50% (CADRADS 1–2), 34 (12.9%) intermediate and 17 (6.5%) severe stenosis.Out of CCS 0 patients, 13 had non-calcified plaque. All-cause mortality rate was 46 (17.0%), with the majority of patients (43 (93.5%) experiencing non-cardiac death and 3 (6.5%) cardiovascular death due to 1 myocardial infarction and 2 cardiopulmonary failure. CADRADS predicted mortality (Kaplan Meir, p<0.001). On multivariate Cox Regression modell, SIS and G-score predicted all-cause mortality (HR 1.1:p=0.034; 95% CI: 0.649–0.983 and HR 1.1, p=0.029; 95% CI: 1.0–1.6), while Calcium Score did not. There were 6 MACE (3 STEMI, 3 NSTEMI). MACE rate was 0% in CADRADS 0 or 1, 1 in CADRADS-2 and increasing to 5 in CADRADS 3 and 4 groups. Coronary CTA for LT risk stratification Conclusion Cardiac CT is a reliable non-invasive modality for pre-LT assessment of CV-risk over a long-term period, with 0% MACE in patients with no CAD or minimal CAD. CTA allows for an improved CV-risk stratification by stenosis severity (CADRADS) and plaque burden as compared to calcium scoring.

scholarly journals Temporal lung changes in high-resolution chest computed tomography for coronavirus disease 2019

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095099
Author(s):  
Chengyang Chen ◽  
Xing Wang ◽  
Jia Dong ◽  
Dianer Nie ◽  
Qianlan Chen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Type I ◽  
Type Ii ◽  
High Resolution Computed Tomography ◽  
Computed Tomographic ◽  
Reticular Pattern ◽  
Ct Radiation ◽  
Diffuse Distribution

Objective To evaluate temporal lung changes in coronavirus disease 2019 (COVID-19) in high-resolution computed tomography (HRCT) and to determine the appropriate computed tomographic (CT) follow-up time. Methods Eighty-six patients with two or more HRCT scans who were diagnosed with COVID-19 were included. The CT score and major CT findings were evaluated. Results Eighty-two (95.3%) patients had lesions on the initial HRCT scans. Most scans showed bilateral, multifocal lung lesions, with multiple lobes involved and diffuse distribution. For fifty-seven patients with type I (progress compared with the initial CT score), the CT score reached a peak at 12 days and the nadir at 36 days. For twenty-nine patients with type II (no progress compared with the initial CT score), the lowest CT score was reached at 23 days. On the final HRCT scans (>21 days), patients with a reticular pattern were older than those without a reticular pattern. Conclusion The appropriate follow-up time of CT scans is during the second week (approximately 12 days) and the fourth to fifth weeks (approximately 23–36 days) from the onset of illness. These times could help reduce the CT radiation dose and show timely changes in the course of the disease by CT.

Intraoperative Gutter Leaks That Merit Our Attention

2017 ◽  
Vol 51 (8) ◽  
pp. 555-561 ◽  
Author(s):  
Adam Tanious ◽  
Mathew Wooster ◽  
Marcelo Giarelli ◽  
Paul A. Armstrong ◽  
Martin R. Back ◽  
...  
Keyword(s):  
De Novo ◽  
Computed Tomographic Angiography ◽  
High Flow ◽  
High Rate ◽  
Low Flow ◽  
Stent Grafts ◽  
Index Procedure ◽  
Computed Tomographic ◽  
Tomographic Angiography

Introduction: The natural history and potential morbidity of gutter endoleaks are unclear. We present our experience with intraoperative gutter endoleaks and strategies to determine which of these require intervention. Methods: This is a retrospective review of all patients treated with parallel stent grafts from January 2010 to September 2015. We reviewed all operative records and intraoperative angiograms as well as all postoperative imaging and secondary interventions. All gutter leaks were classified as low-flow/nonsac-enhancing gutter endoleaks or high-flow/sac-enhancing gutter endoleaks. Adjunctive interventions to manage the gutter leaks were noted, as were all subsequent interventions for gutter leak and endoleak management. Results: Seventy-eight patients had 144 parallel stents placed over a 5-year period with an average of 1.8 stents per patient. Twenty-eight patients (36%) had gutter endoleaks diagnosed intraoperatively. Seventeen patients had adjunctive procedures to reduce gutter leaks prior to leaving the operating room (OR). Patients selected for treatment had gutters filling early during completion angiography and/or contrast enhancement of the aneurysm sac. Twenty-two patients (28%) left the OR with low-flow/delayed/nonsac-enhancing gutter endoleaks. At 30 days, a total of 6 persistent gutter endoleaks were diagnosed on computed tomographic angiography. This gives a 73% rate of resolution for low-flow/nonaneurysm sac-enhancing endoleaks. There were 2 de novo endoleaks not detected at the index procedure diagnosed at 6-month follow-up. Of the 8 total postoperative endoleaks, 5 required additional intervention with a 100% success rate. Multivariate analysis revealed that the only significant predictor of having a postoperative endoleak is leaving the OR with an endoleak. Conclusions: Intraoperative treatment of gutter endoleaks has an acceptable rate of resolution. It does have a high rate of converting high-flow endoleaks to low-flow endoleaks. Low-flow/nonsac-enhancing gutter endoleaks have a high rate of spontaneous resolution. Intraoperative gutter endoleaks are not predictive of future aneurysm sac growth.

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