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Title: Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage After Endovascular Aneurysm Sealing (EVAS)

Abstract

No abstract prepared.

Authors:
;  [1];  [2]
  1. Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)
  2. Tan Tock Seng Hospital, Department of General Surgery (Singapore)
Publication Date:
OSTI Identifier:
22642493
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 7; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; DIAGNOSIS; HEMORRHAGE; RUPTURES; VASCULAR DISEASES

Citation Formats

Pua, Uei, E-mail: druei@yahoo.com, Quek, Lawrence Han Hwee, and Tan, Glenn Wei Leong. Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage After Endovascular Aneurysm Sealing (EVAS). United States: N. p., 2016. Web. doi:10.1007/S00270-015-1291-0.
Pua, Uei, E-mail: druei@yahoo.com, Quek, Lawrence Han Hwee, & Tan, Glenn Wei Leong. Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage After Endovascular Aneurysm Sealing (EVAS). United States. doi:10.1007/S00270-015-1291-0.
Pua, Uei, E-mail: druei@yahoo.com, Quek, Lawrence Han Hwee, and Tan, Glenn Wei Leong. Fri . "Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage After Endovascular Aneurysm Sealing (EVAS)". United States. doi:10.1007/S00270-015-1291-0.
@article{osti_22642493,
title = {Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage After Endovascular Aneurysm Sealing (EVAS)},
author = {Pua, Uei, E-mail: druei@yahoo.com and Quek, Lawrence Han Hwee and Tan, Glenn Wei Leong},
abstractNote = {No abstract prepared.},
doi = {10.1007/S00270-015-1291-0},
journal = {Cardiovascular and Interventional Radiology},
number = 7,
volume = 39,
place = {United States},
year = {Fri Jul 15 00:00:00 EDT 2016},
month = {Fri Jul 15 00:00:00 EDT 2016}
}
  • Elective endovascular treatment of thoracic aortic pathology has been applied in a variety of conditions. The complications of thoracic aortic stenting are also well recognized. Endoleak after endovascular repair of thoracic aortic aneurysms is the most frequent complication; among them, type III is the least frequent. Endovascular treatment of type III endoleak is generally performed under elective conditions; less frequently, in emergency. We report a successful emergency endovascular management of post-thoracic endovascular repair for thoracic aortic aneurysm rupture due to type IIIa endoleak.
  • Reintervention following endovascular aneurysm repair (EVAR) is required in up to 10% of patients at 30 days and is associated with a demonstrable risk of increased mortality. Completion angiography cannot detect all graft-related anomalies and computed tomographic angiography is therefore mandatory to ensure clinical success. Intraoperative angiographic computed tomography (DynaCT; Siemens, Germany) utilizes cone beam reconstruction software and flat-panel detectors to generate CT-like images from rotational angiographic acquisitions. We report the intraoperative use of this novel technology in detecting and immediately treating a proximal anterior type Ia endoleak, following an endovascular abdominal aortic repair, which was not seen on completionmore » angiography. Immediate evaluation of cross-sectional imaging following endograft deployment may allow for on-table correction of clinically significant stent-related complications. This should both improve technical success and minimize the need for early secondary intervention following EVAR.« less
  • The purpose of this study was to report our experience in treating type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. Two hundred eighteen patients underwent EVAR with a Zenith stent-graft from January 2000 to December 2005. During a follow-up period of 4.5 {+-} 2.3 years, solely type II endoleak was detected in 47 patients (22%), and 14 of them underwent secondary interventions to correct this condition. Ten patients had transarterial embolization, and four patients had translumbar/transabdominal embolization. The embolization materials used were coils, thrombin, gelatin, Onyx (ethylene-vinyl alcohol copolymer), and glue. Disappearance of the endoleak withoutmore » enlargement of the aneurysm sac after the first secondary intervention was achieved in only five of these patients (5/13). One patient without surveillance imaging was excluded from analyses of clinical success. After additional interventions in four patients and the spontaneous disappearance of type II endoleak in two patients, overall clinical success was achieved in eight patients (8/12). One patient did not have surveillance imaging after the second secondary intervention. Clinical success after the first secondary intervention was achieved in two patients (2/9) in the transarterial embolization group and three patients (3/4) in the translumbar embolization group. The results of secondary interventions for type II endoleak are unsatisfactory. Although the small number of patients included in this study prevents reliable comparisons between groups, the results seem to favor direct translumbar embolization in comparison to transarterial embolization.« less
  • PurposeThis study was designed to identify parameters on CT angiography (CTA) of type II endoleaks following endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), which can be used to predict the subsequent need for reinterventions.MethodsWe retrospectively identified 62 patients with type II endoleak who underwent early CTA in mean 3.7 ± 1.9 days after EVAR. On the basis of follow-up examinations (mean follow-up period 911 days; range, 373–1,987 days), patients were stratified into two groups: those who did (n = 18) and those who did not (n = 44) require reintervention. CTA characteristics, such as AAA, endoleak, as well as nidus dimensions, patency of the inferior mesentericmore » artery, number of aortic branch vessels, and the pattern of endoleak appearance, were recorded and correlated with the clinical outcome.ResultsUnivariate and receiver operating characteristic curve regression analyses revealed significant differences between the two groups for the endoleak volume (surveillance group: 1391.6 ± 1427.9 mm{sup 3}; reintervention group: 3227.7 ± 2693.8 mm{sup 3}; cutoff value of 2,386 mm{sup 3}; p = 0.002), the endoleak diameter (13.6 ± 4.3 mm compared with 25.9 ± 9.6 mm; cutoff value of 19 mm; p < 0.0001), the number of aortic branch vessels (2.9 ± 1.2 compared with 4.2 ± 1.4 vessels; p = 0.001), as well as a “complex type” endoleak pattern (13.6 %, n = 6 compared with 44.4 %, n = 8; p = 0.02).ConclusionsEarly CTA can predict the future need for reintervention in patients with type II endoleak. Therefore, treatment decision should be based not only on aneurysm enlargement alone but also on other imaging characteristics.« less
  • PurposeTo assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR).Materials and MethodsWe performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks.ResultsData were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greatermore » in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was −4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002).ConclusionPatients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.« less