Advertisement

Dynamic Computed Tomography Angiography is More Accurate in Diagnosing Endoleaks than Standard Triphasic Computed Tomography Angiography and Enables Targeted Embolization

      Background

      The primary objective was to compare the accuracy of dynamic computed tomography (CT) angiography (d-CTA) with standardized triphasic contrast enhanced CT angiography (t-CTA) in diagnosing endoleak type after endovascular aortic repair (EVAR) using digital subtraction angiography (DSA) as reference standard. The secondary objective was to study the impact of d-CTA on image fusion–guided endoleak embolization.

      Methods

      A retrospective review of patients who underwent d-CTA imaging after EVAR between March 2019 and July 2021 was performed. Deidentified images were independently reviewed by two-two blinded readers to document endoleak type and target vessels. An impact of d-CTA–guided embolization was evaluated by a number of planning angiograms, radiation exposure, and accuracy of target vessel overlay.

      Results

      During the study period, 52 patients underwent d-CTA and 19 had all 3 modalities available for analysis. DSA imaging confirmed 4 (21.0%) type-I, 14 (73.7%) type-II, and 1 (5.3%) type-III endoleak. Findings from d-CTA matched with DSA in 19/19 cases (100%), whereas t-CTA matched in 14/19 cases (73.7%). In type-II endoleaks, the number of target vessels identified by d-CTA, t-CTA, and DSA were 23, 17, and 16, respectively. Mean dose-length product from d-CTA and t-CTA was 1,445 ± 551 and 1,612 ± 530 mGy × cm (P = 0.26). Nine patients underwent d-CTA–guided type-II endoleak embolization, using a median of 1 (range: 1–4) planning angiogram before embolization using 21.6 (± 8.7)% of total procedural radiation dose. Target vessel overlay was accurate in 9/9 (100%) cases.

      Conclusions

      Dynamic, time-resolved CTA is more accurate compared to standardized triphasic contrast enhanced CTA in diagnosing endoleak type after EVAR. In type-II endoleak, d-CTA better identified target vessels and enabled safe, targeted embolization.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chaikof E.L.
        • Dalman R.L.
        • Eskandari M.K.
        • et al.
        The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67: 2-77.e2
        • Wanhainen A.
        • Verzini F.
        • Van Herzeele I.
        • et al.
        Editor's choice - European society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.
        Eur J Vasc Endovasc Surg. 2019; 57: 8-93
        • Boyle J.R.
        • Mao J.
        • Beck A.W.
        • et al.
        Editor's choice - variation in intact abdominal aortic aneurysm repair outcomes by country: analysis of international consortium of vascular registries 2010 - 2016.
        Eur J Vasc Endovasc Surg. 2021; 62: 16-24
        • Lehmkuhl L.
        • Andres C.
        • Lücke C.
        • et al.
        Dynamic CT angiography after abdominal aortic endovascular aneurysm repair: influence of enhancement patterns and optimal bolus timing on endoleak detection.
        Radiology. 2013; 268: 890-899
        • Madigan M.C.
        • Singh M.J.
        • Chaer R.A.
        • et al.
        Occult type I or III endoleaks are a common cause of failure of type II endoleak treatment after endovascular aortic repair.
        J Vasc Surg. 2019; 69: 432-439
        • Hou K.
        • Zhu T.
        • Zhang W.
        • et al.
        Dynamic volumetric computed tomography angiography is a preferred method for unclassified endoleaks by conventional computed tomography angiography after endovascular aortic repair.
        J Am Heart Assoc. 2019; 8: e012011
        • Lowe C.
        • Abbas A.
        • Rogers S.
        • et al.
        Three-dimensional contrast-enhanced ultrasound improves endoleak detection and classification after endovascular aneurysm repair.
        J Vasc Surg. 2017; 65: 1453-1459
        • Berczeli M.
        • Lumsden A.B.
        • Chang S.M.
        • et al.
        Dynamic, time-resolved computed tomography angiography technique to characterize aortic endoleak type, inflow and provide guidance for targeted treatment.
        J Endovasc Ther. 2022; 29: 11-22
        • Charalambous S.
        • Perisinakis K.
        • Kontopodis N.
        • et al.
        Discrimination of high-risk type-2 endoleak after endovascular aneurysm repair through CT perfusion: a feasibility study.
        J Vasc Interv Radiol. 2021; 32: 807-812
        • Koike Y.
        • Ishida K.
        • Hase S.
        • et al.
        Dynamic volumetric CT angiography for the detection and classification of endoleaks: application of cine imaging using a 320-row CT scanner with 16-cm detectors.
        J Vasc Interv Radiol. 2014; 25: 1172-11780.e1
        • Apfaltrer G.
        • Lavra F.
        • Schoepf U.J.
        • et al.
        Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: a feasibility study.
        PLoS One. 2021; 16: e0245134
        • Sommer W.H.
        • Becker C.R.
        • Haack M.
        • et al.
        Time-resolved CT angiography for the detection and classification of endoleaks.
        Radiology. 2012; 263: 917-926
        • Berczeli M.
        • Chinnadurai P.
        • Chang S.M.
        • et al.
        Time-resolved, dynamic computed tomography angiography for characterization of aortic endoleaks and treatment guidance via 2D-3D fusion-imaging.
        J Vis Exp. 2021; https://doi.org/10.3791/62958
        • Ultee K.H.J.
        • Büttner S.
        • Huurman R.
        • et al.
        Editor's choice - systematic review and meta-analysis of the outcome of treatment for type II endoleak following endovascular aneurysm repair.
        Eur J Vasc Endovasc Surg. 2018; 56: 794-807
        • Sidloff D.A.
        • Stather P.W.
        • Choke E.
        • et al.
        Type II endoleak after endovascular aneurysm repair.
        Br J Surg. 2013; 100: 1262-1270
        • Aziz A.
        • Menias C.O.
        • Sanchez L.A.
        • et al.
        Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion.
        J Vasc Surg. 2012; 55: 1263-1267
        • Bent C.L.
        • Jaskolka J.D.
        • Lindsay T.F.
        • et al.
        The use of dynamic volumetric CT angiography (DV-CTA) for the characterization of endoleaks following fenestrated endovascular aortic aneurysm repair (f-EVAR).
        J Vasc Surg. 2010; 51: 203-206
        • Sommer W.H.
        • Clevert D.A.
        • Bamberg F.
        • et al.
        Time-resolved computed tomography imaging of the aorta: a feasibility study.
        J Thorac Imaging. 2010; 25: 161-167
        • Zaarour Y.
        • Kobeiter H.
        • Derbel H.
        • et al.
        Immediate and 1-year success rate of type 2 endoleak treatment using three-dimensional image fusion guidance.
        Diagn Interv Imaging. 2020; 101: 589-598
        • Yu H.
        • Desai H.
        • Isaacson A.J.
        • et al.
        Comparison of type II endoleak embolizations: embolization of endoleak nidus only versus embolization of endoleak nidus and branch vessels.
        J Vasc Interv Radiol. 2017; 28: 176-184