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Title: The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA

Abstract

PurposeTo determine the influence of preoperative aneurysmal thrombus quantity and distribution on the development of type II endoleak with aneurysm sac enlargement after endovascular aneurysm repair (EVAR).Materials and MethodsWe retrospectively analyzed the pre- and postoperatively performed CT scans of 118 patients who had follow-up imaging for at least 1 year after EVAR available. We assessed preoperative thrombus perimeter (T{sub Peri}), diameter (T{sub Dia}), cross-sectional area (T{sub CSA}), and volume (T{sub Vol}). The preoperative thrombus distribution was classified into no thrombus, semilunar-shaped (anterior, right side, left side, posterior) thrombus, and circumferential type thrombus. The number of preoperative patent aortic side branches (ASB) was identified. Endpoint was type II endoleak with aneurysm volume (A{sub Vol}) increase of ≥5 % during follow-up.ResultsDuring follow-up (2 years, range 1–9 years), 17 patients with type II endoleak had significant A{sub Vol} increase. Less preoperative T{sub Peri}, T{sub Dia}, T{sub CSA}, and T{sub Vol} were associated with A{sub Vol} increase. A circumferential thrombus distribution significantly protected against aneurysm enlargement (p = 0.028). The variables with the strongest significance for A{sub Vol} increase were preoperative T{sub Vol}/A{sub Vol} ratio (OR 0.95; p = 0.037) and number of patent ASB (OR 3.52; p < 0.001).ConclusionA low preoperative T{sub Vol}/A{sub Vol} ratio and a high number of patent ASB weremore » associated with aneurysm sac enlargement after EVAR.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [1]; ;  [6]; ;  [1]
  1. University Medical Center Regensburg, Department of Radiology (Germany)
  2. Dr. Neumaier MVZ GmBH Castra Regina Center (Germany)
  3. University Medical Center Regensburg, Center for Clinical Studies (Germany)
  4. University Hospital of Würzburg, Department of Diagnostic and Interventional Radiology (Germany)
  5. Kantonsspital Schaffhausen, Department of Radiology and Nuclear Medicine (Switzerland)
  6. University Medical Center Regensburg, Department of Vascular Surgery (Germany)
Publication Date:
OSTI Identifier:
22645470
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 8; 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; CAT SCANNING; IMAGE PROCESSING; PATENTS; PATIENTS; REPAIR; VASCULAR DISEASES

Citation Formats

Müller-Wille, R., E-mail: rene.mueller-wille@ukr.de, Güntner, O., E-mail: oliverguentner@yahoo.de, Zeman, F., E-mail: florian.zeman@ukr.de, Dollinger, M., E-mail: Dollinger-M@ukw.de, Hälg, C., E-mail: haelg@gmx.ch, Beyer, L. P., E-mail: lukas.beyer@ukr.de, Pfister, K., E-mail: karin.pfister@ukr.de, Kasprzak, P., E-mail: gefaess.chirurgie@ukr.de, Stroszczynski, C., E-mail: christian.stros@ukr.de, and Wohlgemuth, W. A., E-mail: walter.wohlgemuth@ukr.de. The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1386-2.
Müller-Wille, R., E-mail: rene.mueller-wille@ukr.de, Güntner, O., E-mail: oliverguentner@yahoo.de, Zeman, F., E-mail: florian.zeman@ukr.de, Dollinger, M., E-mail: Dollinger-M@ukw.de, Hälg, C., E-mail: haelg@gmx.ch, Beyer, L. P., E-mail: lukas.beyer@ukr.de, Pfister, K., E-mail: karin.pfister@ukr.de, Kasprzak, P., E-mail: gefaess.chirurgie@ukr.de, Stroszczynski, C., E-mail: christian.stros@ukr.de, & Wohlgemuth, W. A., E-mail: walter.wohlgemuth@ukr.de. The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA. United States. doi:10.1007/S00270-016-1386-2.
Müller-Wille, R., E-mail: rene.mueller-wille@ukr.de, Güntner, O., E-mail: oliverguentner@yahoo.de, Zeman, F., E-mail: florian.zeman@ukr.de, Dollinger, M., E-mail: Dollinger-M@ukw.de, Hälg, C., E-mail: haelg@gmx.ch, Beyer, L. P., E-mail: lukas.beyer@ukr.de, Pfister, K., E-mail: karin.pfister@ukr.de, Kasprzak, P., E-mail: gefaess.chirurgie@ukr.de, Stroszczynski, C., E-mail: christian.stros@ukr.de, and Wohlgemuth, W. A., E-mail: walter.wohlgemuth@ukr.de. 2016. "The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA". United States. doi:10.1007/S00270-016-1386-2.
@article{osti_22645470,
title = {The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA},
author = {Müller-Wille, R., E-mail: rene.mueller-wille@ukr.de and Güntner, O., E-mail: oliverguentner@yahoo.de and Zeman, F., E-mail: florian.zeman@ukr.de and Dollinger, M., E-mail: Dollinger-M@ukw.de and Hälg, C., E-mail: haelg@gmx.ch and Beyer, L. P., E-mail: lukas.beyer@ukr.de and Pfister, K., E-mail: karin.pfister@ukr.de and Kasprzak, P., E-mail: gefaess.chirurgie@ukr.de and Stroszczynski, C., E-mail: christian.stros@ukr.de and Wohlgemuth, W. A., E-mail: walter.wohlgemuth@ukr.de},
abstractNote = {PurposeTo determine the influence of preoperative aneurysmal thrombus quantity and distribution on the development of type II endoleak with aneurysm sac enlargement after endovascular aneurysm repair (EVAR).Materials and MethodsWe retrospectively analyzed the pre- and postoperatively performed CT scans of 118 patients who had follow-up imaging for at least 1 year after EVAR available. We assessed preoperative thrombus perimeter (T{sub Peri}), diameter (T{sub Dia}), cross-sectional area (T{sub CSA}), and volume (T{sub Vol}). The preoperative thrombus distribution was classified into no thrombus, semilunar-shaped (anterior, right side, left side, posterior) thrombus, and circumferential type thrombus. The number of preoperative patent aortic side branches (ASB) was identified. Endpoint was type II endoleak with aneurysm volume (A{sub Vol}) increase of ≥5 % during follow-up.ResultsDuring follow-up (2 years, range 1–9 years), 17 patients with type II endoleak had significant A{sub Vol} increase. Less preoperative T{sub Peri}, T{sub Dia}, T{sub CSA}, and T{sub Vol} were associated with A{sub Vol} increase. A circumferential thrombus distribution significantly protected against aneurysm enlargement (p = 0.028). The variables with the strongest significance for A{sub Vol} increase were preoperative T{sub Vol}/A{sub Vol} ratio (OR 0.95; p = 0.037) and number of patent ASB (OR 3.52; p < 0.001).ConclusionA low preoperative T{sub Vol}/A{sub Vol} ratio and a high number of patent ASB were associated with aneurysm sac enlargement after EVAR.},
doi = {10.1007/S00270-016-1386-2},
journal = {Cardiovascular and Interventional Radiology},
number = 8,
volume = 39,
place = {United States},
year = 2016,
month = 8
}
  • Purpose: To determine the feasibility and efficacy of transarterial endoleak embolization using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx). Methods: Over a 7-year period eleven patients (6 women, 5 men; mean age 68 years, range 37-83 years) underwent transarterial embolization of a type II endoleak after endovascular aortic aneurysm repair using the liquid embolic agent Onyx. Two patients (18 %) had a simple type II endoleak with only one artery in communication with the aneurysm sac, whereas 9 patients (82 %) had a complex type II endoleak with multiple communicating vessels. We retrospectively analyzed the technical and clinicalmore » success of transarterial type II endoleak embolization with Onyx. Complete embolization of the nidus was defined as technical success. Embolization was considered clinically successful when volume of the aneurysm sac was stable or decreased on follow-up CT scans. Result: Mean follow-up time was 26.0 (range 6-50) months. Clinical success was achieved in 8 of 11 patients (73 %). Transarterial nidus embolization with Onyx was technically successful in 6 of 11 patients (55 %). In three cases the nidus was embolized without direct catheterization from a more distal access through the network of collateral vessels. Conclusion: Onyx is a favorable embolic agent for transarterial endoleak embolization. To achieve the best clinical results, complete occlusion of the nidus is mandatory.« less
  • Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.
  • Nellix Endovascular Aneurysm Sealing (EVAS) system is a new concept and technology of abdominal aortic aneurysm (AAA) repair. Elective EVAS using Nellix device was performed for a 83-year-old man with AAA. 2-month post-EVAS CTA surveillance demonstrated mild enlargement of aneurysmal sac and separation of the EndoBags, but without detectable endoleak. The patient developed sudden AAA rupture with retroperitoneal hematoma at about 4 months after EVAS. We postulated that early enlargement of aneurysmal sac and separation of EndoBags of Nellix devices after EVAS, even without detectable endoleak, might indicate significant aneurysmal wall weakening with increased risk of later AAA rupture. To themore » best of the authors’ knowledge, this was the first reported case of aortic rupture after EVAS without detectable endoleak during and after the procedure.« less
  • Type 2 endoleaks (EL2) are the most commonly encountered endoleaks following EVAR. Despite two decades of experience, there remains considerable variation in the management of EL2 with controversies ranging from if to treat, when to treat and how to treat. Here, we summarise the available evidence, describe the treatment techniques available and offer guidelines for management.
  • No abstract prepared.