Dynamic Volumetric Computed Tomography Angiography Is a Preferred Method for Unclassified Endoleaks by Conventional
Kai Hou1, Ting Zhu2, Wei Zhang3
11 Department of Radiology Shanghai Institute of Medical Imaging Zhongshan Hospital Fudan University Shanghai China.
Insights
Dynamic volumetric computed tomography angiography (DV-CTA) offers a safe and effective alternative for classifying endoleaks after endovascular aortic repair. This method reduces contrast agent and radiation exposure compared to conventional CTA.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Imaging
Background:
- Endovascular aortic repair (EVAR) is a common treatment for abdominal aortic aneurysms.
- Endoleaks are a potential complication after EVAR, requiring accurate classification for timely intervention.
- Conventional computed tomography angiography (CTA) can sometimes fail to classify endoleaks definitively.
Purpose of the Study:
- To evaluate the feasibility and safety of dynamic volumetric computed tomography angiography (DV-CTA) for endoleak classification.
- To compare DV-CTA with conventional CTA in patients with unclassified endoleaks post-EVAR.
- To assess the diagnostic accuracy of DV-CTA against digital subtraction angiography (DSA).
Main Methods:
- A randomized controlled trial involving 24 patients with unclassified endoleaks after EVAR.
- Patients were assigned to either conventional CTA or DV-CTA for further evaluation.
- Comparison of contrast agent volume, radiation dose, and creatinine changes between groups.
- Reintervention was performed based on endoleak classification, with 6- and 12-month follow-up.
Main Results:
- DV-CTA demonstrated comparable accuracy to DSA in classifying endoleaks.
- The DV-CTA group showed a significant reduction in contrast agent (14.0%) and radiation dosage (12.1%) compared to conventional CTA.
- No cases of contrast-induced nephropathy were observed in either group.
- All identified endoleaks were successfully treated, with no recurrence during follow-up.
Conclusions:
- DV-CTA is a viable alternative to DSA for classifying challenging endoleaks post-EVAR.
- DV-CTA significantly reduces contrast and radiation exposure, enhancing patient and operator safety.
- This advanced imaging technique improves the management of endoleaks following EVAR.
Abstract:
Background The aim of this study was to assess the feasibility and safety of dynamic volumetric computed tomography angiography ( DV - CTA ) for endoleaks detected but not classified by conventional CTA in patients after endovascular aortic repair. Methods and Results From January 2016 to October 2017, 24 patients with endoleaks with aneurysm sac enlargement detected but not classified by conventional CTA were randomly assigned to the conventional CTA group and the DV - CTA group for further evaluation. The amount of contrast agent, radiation dosage, and changes in creatinine during the operation were compared between the 2 groups. Reintervention was performed according to the endoleak classification followed by the 6- and 12-month follow-up. The accuracy of classifying endoleaks by DV - CTA was comparable to that by digital subtraction angiography. Additionally, the total amount of contrast agent and the radiation dosage in the DV - CTA group during the operation were diminished by 14.0% ( P=0.007) and 12.1% ( P=0.004), respectively, compared with those in the conventional CTA group. No contrast-induced nephropathy was observed. All endoleaks were treated instantly after identification. No endoleaks were found in any of the patients during follow-up. Conclusions DV - CTA could replace digital subtraction angiography as an alternative method for the classification of endoleaks that cannot be differentiated by conventional CTA . Additionally, the amount of contrast agent and the total radiation dosage were substantially reduced, which improved safety among operators and patients.
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