[Endoleak characterization after endovascular aortic aneurysm repair using dynamic CT angiography]

Area of Science:

• Medical Imaging
• Vascular Surgery
• Radiology

Background:

• Standard triphasic CT angiography can be challenging for characterizing endoleaks post-EVAR.
• Dynamic CT angiography (CTA) is an emerging technique for improved endoleak assessment.

Purpose of the Study:

• To evaluate the efficacy of dynamic CTA in characterizing difficult-to-diagnose endoleaks following EVAR.
• To compare dynamic CTA findings with standard triphasic CT angiography.

Main Methods:

• Dynamic CTA was performed on 15 patients with uncertain endoleaks or growing aneurysms post-EVAR.
• Image series were acquired at specific intervals and analyzed using functional CT software based on temporal changes in Hounsfield units.
• Philips Brilliance iCT 256 scanner and Philips IntelliSpace Portal Functional CT software were utilized.

Main Results:

• Dynamic CTA successfully identified exact endoleak types in 7 cases previously undetermined.
• Two cases reclassified from Type V to Type II endoleaks.
• Identified specific perfusion sources (inferior mesenteric artery, lumbar arteries) for Type II endoleaks and confirmed occlusion in one case.

Conclusions:

• Dynamic CTA is a valuable adjunct to standard triphasic CT angiography for EVAR follow-up.
• It enhances the characterization of complex endoleaks, facilitating targeted therapeutic interventions.
• This technique shows promise for improving patient management after EVAR.