Type II lumbar endoleaks: Hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular aneurysm repair

• Published in: Journal of vascular surgery 2005, Vol.41 (1), p.10-18
• Main Authors: Bargellini, Irene, Napoli, Vinicio, Petruzzi, Pasquale, Cioni, Roberto, Vignali, Claudio, Sardella, Savino G., Ferrari, Mauro, Bartolozzi, Carlo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Contrast Media; Diseases of the aorta; Hemodynamics; Humans; Lumbosacral Region; Male; Medical sciences; Middle Aged; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Ultrasonography; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2004.10.037

The objective of this study was to differentiate type II lumbar endoleaks on the basis of dynamic features identified by contrast-enhanced ultrasound scanning (CUS) and to evaluate the role of this differentiation in detecting abdominal aortic aneurysm (AAA) enlargement ≥1 mL/mo. Eighteen male patients (mean age, 71.8 years) with type II lumbar endoleak suspected at CUS underwent computed tomography angiography (CTA) and digital subtraction angiography (DSA). On CTA, AAA volumes and endoleak visualization and volume were assessed. At CUS, performed after a bolus of 1.5 to 2.4 mL of a second generation blood pool contrast agent, the following parameters were evaluated: presence of contrast material within the aneurysmal sac (endoleak), delay of endoleak detection (wash-in) and disappearance (washout) from the beginning of contrast injection, visualization of inflow and outflow vessels, and presence of cavity filling. Statistical analysis was performed regarding endoleak features at CUS, endoleak detection at CTA, and rate of AAA enlargement. DSA confirmed all the endoleaks. Mean ± standard deviation wash-in and washout times were 121.9 ± 132.6 and 337.2 ± 193.7 seconds, respectively; a significant relation was observed between these two parameters ( P < .01, analysis of variance). By Youden plots, endoleaks were classified as hyperdynamic when wash-in was