Published in:
01-06-2006 | UPDATE
Diagnosis and management of endoleaks after endovascular aneurysm repair: role of MRI
Published in: Abdominal Radiology | Issue 3/2006
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Endovascular aneurysm treatment has been performed since the 1990s and has emerged as an alternative to open surgery in suitable high-risk patients. In comparison with the conventional operation, periprocedural risk and hospital stay are clearly decreased [1, 2]. With increasing experience and numbers treated, acute peri-interventional complications have become more and more infrequent. However, for maintenance of treatment results, reintervention has to be taken into account in about one-fourth of cases [3‐5]. The geometry of the aneurysm sac and the consistency of the aneurysm wall remain unchanged in the first instance. Therefore, the primary goal of endovascular aneurysm treatment is complete sealing of the aneurysm sac from blood flow to achieve general pressure relief and avoid aneurysm rupture. In case of continuing blood flow within the aneurysm sac, i.e., endoleaks, significantly increased blood pressure remains within the aneurysm. The prognostic effect of such endoleaks has been realized with increasing clinical experience. Complete aneurysm exclusion often results in shrinkage of the aneurysm sac. However, endoleaks result in decreased aneurysm shrinkage, aneurysm growth, and even fatal rupture [6‐15]. Aneurysm growth in turn indicates increased pressure load of the aneurysm sac, even if an causative endoleak cannot be proved by means of diagnostic imaging [12, 13, 16]. Because a favorable clinical outcome depends on freedom from endoleaks, reliable endoleak detection and the imaging modality used for follow-up is crucial. This report focuses on the diagnostic effect of magnetic resonance imaging (MRI) and computed tomography (CT) for endoleak detection and describes the current endoleak classification (Table 1) and treatment options.|
Endoleak types
|
Sources of endoleak
|
|---|---|
|
Type 1
|
Attachment site leaks a
|
|
A
|
Proximal attachment
|
|
B
|
Distal attachment
|
|
C
|
Iliac occluder
|
|
Type II
|
Collateral vessel leaks b
|
|
A
|
Simple or to and from (only 1 patent branch)
|
|
B
|
Complex leaks (≥2 patent branches)
|
|
Type III
|
Defective stent graft a
|
|
A
|
Junctional leak or disconnect
|
|
B
|
Fabric disruption (midgraft hole)
|
|
C
|
Other causes (suture holes, etc.)
|
|
Type IV
|
Graft wall porosity
|
|
Type V
|
Endotension
|
|
A
|
With no endoleak c
|
|
B
|
With sealed endoleak (virtual endoleak)
|
|
C
|
With type I or III leak d
|
|
D
|
With type II leak d
|