Clinical Significance of Endoleak Detected on Follow-Up CT After Endovascular Repair of Abdominal Aortic Aneurysm
Cheng Hong1,
Jay P. Heiken2,
Gregorio A. Sicard3,
Thomas K. Pilgram2 and
Kyongtae T. Bae4
1 Department of Radiology, University of Chicago, Chicago, IL.
2 Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St. Louis, MO.
3 Department of Surgery, Division of Vascular Surgery, Washington University
School of Medicine, St. Louis, MO.
4 Department of Radiology, University of Pittsburgh School of Medicine, 3362
Fifth Ave., Pittsburgh, PA 15213.
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Fig. 1A —83-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse unenhanced CT scan 36 months after
repair shows interval disruption (arrow) of anterior aspect of
stent–graft within aneurysmal sac.
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Fig. 1B —83-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse arterial phase CT scan 36 months after
repair shows small blush of perigraft flow (arrow) posterior to
stent–graft at level of stent separation (type III endoleak).
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Fig. 1C —83-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse unenhanced (C) and arterial phase
(D) follow-up CT scans 5 months after endovascular cuff placement show
successful repair of stent disruption and no evidence of endoleak.
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Fig. 1D —83-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse unenhanced (C) and arterial phase
(D) follow-up CT scans 5 months after endovascular cuff placement show
successful repair of stent disruption and no evidence of endoleak.
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Fig. 2A —78-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse arterial phase CT scan obtained at
24-month follow-up examination does not show perigraft leak that is evident in
B.
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Fig. 2B —78-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Delayed phase CT scan obtained at same examination
as A shows approximately 1-cm area of perigraft leak (arrow)
along posterior aspect of bifurcated limbs of stent–graft in region of
inferior aspect of aneurysmal sac.
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Fig. 2C —78-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse arterial (C) and delayed
(D) phase CT scans obtained at 48-month follow-up examination show
resolution of endoleak.
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Fig. 2D —78-year-old man after endovascular aneurysm repair of
abdominal aortic aneurysm. Transverse arterial (C) and delayed
(D) phase CT scans obtained at 48-month follow-up examination show
resolution of endoleak.
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Fig. 3 —Mosaic plot shows outcomes of endoleaks detected in various
phases of CT. Endoleaks detected in arterial phase only, delayed phase only,
and both phases had resolution rates of 75% (six of eight grafts), 100% (eight
of eight grafts), and 50% (17 of 34 grafts). Light gray indicates resolution;
dark gray, lack of resolution.
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Fig. 4 —Scatterplot shows change in diameter of abdominal aortic
aneurysm with endoleaks detected only in delayed phase of CT examination.
Aneurysms tended to shrink over time. Overall diameter decrease of 2.4 mm was
statistically significant (analysis of variance, p = 0.0045).
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Fig. 5 —Scatterplot shows change in diameter of abdominal aortic
aneurysm after intervention for endoleak. Aneurysms enlarged after
approximately 1 year of stable measurements. Upward trend in size was
statistically significant (analysis of variance, p < 0.0001).
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Fig. 6 —Scatterplot shows change in diameter of abdominal aortic
aneurysm with endoleaks resolved. Tendency for most measurements to decrease
slightly balanced tendency of few to increase greatly, resulting in almost
level overall trend (analysis of variance, p = 1.00).
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Copyright © 2008 by the American Roentgen Ray Society.
