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.
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Article Info
Publication History
Published online: July 07, 2022
Accepted:
June 12,
2022
Received:
April 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: ABL receives research support from Siemens Medical Solutions USA Inc . PC is full-time employees of Siemens Medical Solutions USA Inc. MB is supported by Semmelweis University’s scholarship: EFOP-3.6.3- VEKOP-16-2017-00009 . The authors would like to acknowledge the support from Juan Carlos Ramirez-Giraldo, Myra S Cocker, Danielle Jones from Siemens for their support with imaging protocol setup and optimization. The authors would also like to acknowledge the support from CT imaging technologists: Janette Bell, Miguel A Jimenez, Stephanie K. Johnson, Janette Canell.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
