scholarly journals Imaging techniques in the assessment of endovascular infrarenal abdominal aortic repair

2020 ◽  
Vol 73 (1-2) ◽  
pp. 29-35
Author(s):  
Aleksandar Spasic ◽  
Viktor Till ◽  
Marijana Basta-Nikolic ◽  
Djordje Milosevic ◽  
Darka Hadnadjev-Simonji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Imaging Techniques ◽  
First Year ◽  
Imaging Method ◽  
Diagnostic Modality ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Enhanced Computed Tomography

Introduction. Imaging is essential in the assessment of endovascular infrarenal abdominal aortic repair results. Complications include endoleaks, graft migration, kinking and infolding, stenosis, occlusion, and secondary ruptures. Examination Modalities. Contemporary imaging strategies are based on using noninvasive imaging modalities. After endovascular infrarenal abdominal aortic repair, the standard evaluation modality is computed tomography angiography, whereas additional modalities include magnetic resonance imaging, ultrasonography, and radiography. However, although an invasive imaging method, digital subtraction angiography is still performed in some patients. Computed tomography angiography provides excellent contrast, spatial resolution, and exact measurements of structures of interest, which is essential in the follow-up. Follow-up Protocol. Currently recommended follow-up protocol in the first year is contrast- enhanced computed tomography imaging at 1 and 12 months after the procedure. Conclusion. Due to its characteristics, reproducibility and availability, computed tomography angiography remains the cornerstone diagnostic modality of post-procedural assessment in patients with endovascular infrarenal abdominal aortic repair.

Successful Embolization of Persistent Endoleak from a Patent Inferior Mesenteric Artery

1997 ◽  
Vol 4 (3) ◽  
pp. 312-315 ◽  
Author(s):  
Greg van Schie ◽  
Kishore Sieunarine ◽  
Mike Holt ◽  
Michael Lawrence-Brown ◽  
David Hartley ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Aortic Aneurysm ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Retrograde Filling ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Purpose: To report the successful endovascular occlusion of a persistent endoleak owing to collateral perfusion in a 1-year-old bifurcated aortic endograft. Methods and Results: An 81-year-old man underwent endovascular repair of a 5.5-cm abdominal aortic aneurysm (AAA) with a bifurcated stent-graft in 1995; collateral perfusion of the excluded aneurysm by retrograde filling of the patent inferior mesenteric artery (IMA) was noted postoperatively. At his 1-year follow-up, the mid-sac endoleak persisted on contrast-enhanced computed tomography. Using the superior mesenteric artery for access, the stump of the IMA was successfully embolized with glue. Conclusions: This case, which highlights the importance of documenting a patent IMA prior to AAA endografting, illustrates one option for the management of persistent collateral perfusion of endovascularly excluded aneurysms.

Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

2020 ◽  
pp. 152660282096248
Author(s):  
José Oliveira-Pinto ◽  
Rita Soares-Ferreira ◽  
Nelson F. G. Oliveira ◽  
Elke Bouwens ◽  
Frederico M. Bastos Gonçalves ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Late Complications ◽  
Aortic Aneurysms ◽  
First Year ◽  
Volume Changes ◽  
Tertiary Referral ◽  
Abdominal Aortic ◽  
The Mean ◽  
The Impact

Purpose To compare changes in abdominal aortic aneurysm (AAA) sac volume between endovascular aneurysm repairs (EVAR) performed for ruptured (rEVAR) vs intact (iEVAR) AAAs and to determine the impact of early volume shrinkage on future complications. Materials and Methods A retrospective analysis was performed of all patients undergoing standard infrarenal EVAR from 2002 to 2016 at a tertiary referral institution. Only patients with degenerative AAAs and with 30-day and 1-year computed tomography angiography (CTA) imaging were included. Early sac shrinkage was defined as a volume sac reduction >10% between the first (<30-day) and the 1-year CTA. The primary endpoint was to compare AAA sac volume changes between patients undergoing rEVAR (n=51; mean age 71.0±8.5 years; 46 men) vs iEVAR (n=393; mean age 72.3±7.5 years; 350 men). Results are reported as the mean difference with the interquartile range (IQR Q1, Q3). The secondary endpoint was freedom from aneurysm-related complications after 1 year as determined by regression analysis; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results At baseline, the rEVAR group had larger aneurysms (p<0.001) and shorter (p<0.001) and more angulated (p=0.028) necks. Aneurysm sac volume decreased more in the rEVAR group during the first year [−26.3% (IQR −38.8%, −12.5%)] vs the iEVAR group [−11.9% (IQR −27.5%, 0); p<0.001]. However, after the first year, the change in sac volume was similar between the groups [−3.8% (IQR −32.9%, 31.9%) for rEVAR and −1.5% (IQR −20.9%, 13.6%) for iEVAR, p=0.74]. Endoleak occurrence during follow-up was similar between the groups. In the overall population, patients with early sac shrinkage had a lower incidence of complications after the 1-year examination (adjusted HR 0.59, 95% CI 0.39 to 0.89, p=0.01). Conclusion EVAR patients treated for rupture have more pronounced aneurysm sac shrinkage compared with iEVAR patients during the first year after EVAR. Patients presenting with early shrinkage are less likely to encounter late complications. These parameters may be considered when tailoring surveillance protocols.

scholarly journals Duplex Ultrasound Versus Computed Tomography for Follow Up of Complications after Evar with Nellix Endograft: First Clinical Experience

2013 ◽  
Vol 13 (1) ◽  
pp. 28-33
Author(s):  
Natalija Ezite ◽  
Janis Savlovskis ◽  
Marcis Gedins ◽  
Kaspars Kisis ◽  
Polina Dombure ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Imaging Techniques ◽  
Duplex Ultrasound ◽  
Graft Patency ◽  
Imaging Modalities ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
The Cost ◽  
New Generation

Summary Introduction.Contrast-enhanced computed tomography (CT) has become the ‘gold-standard’ imaging modality for surveillance following EVAR (2, 20). However repeated CT is related to increased cost, risk of contrast nephropathy and radiation exposure. Duplex ultrasound (DUS) is a less invasive but considered less accurate method than CT. Aim of the study. The aim of this study was to determine the diagnostic accuracy of both imaging modalities for detection of complications in post-EVAR patients where the new generation sac-sealing endograft was used and to compare cost-effectiveness and sensitivity of both imaging modalities. Methods. Analysis of 23 post-EVAR patients with implantation of new generation sac-sealing endograft device (Nellix®, Endologix, USA) was performed, making a comparison of CT and DUS. Contrast-enhanced computed tomography was taken as the ‘goldstandard’ investigation. DUS was compared to CT for analysis of sensitivity, post-imaging complications and cost-effectiveness. Statistical analysis of data was performed using v19.0 SPSS software (IBM). Results. Analysis of CT and DUS studies compared in 23 patients. Both imaging modalities can detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between two imaging techniques is substantial. Our results demonstrate that DUS surveillance during follow-up after EVAR where new generation sac-sealing endograft is used can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and eliminating CT related radiation and nephrotoxicity. Conclusion. CT and DUS imaging can both detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between the two imaging techniques is substantial. Our results demonstrate that in post-EVAR patients where new-generation sac-sealing endograft was deployed DUS surveillance performed by experienced radiologist can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and avoiding CT-related complications.

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