ARRS 2022 Abstracts

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E2027. Dynamic Volumetric Computed Tomography Angiography (CTA) for Endoleak Evaluation: Why and How To Do It
Authors
  1. Livia Maria Frota Lima; Mayo Clinic
  2. Nila Akhtar; Mayo Clinic
  3. Nikkole Weber; Mayo Clinic
  4. Shuai Leng; Mayo Clinic
  5. Gustavo Oderich; UTHealth McGovern Medical School
  6. Thanila Macedo; UTHealth McGovern Medical School
Objective:
The purpose of this study is to report our experience with dynamic CTA performed at our institution, including the indications and technique used during the last 24 months.

Materials and Methods:
An IRB-approved retrospective review was conducted of patients who underwent dynamic CTA for endoleak characterization at our institution since we started using this technology in the last 24 months. Patient demographic data, clinical, and surgical history and image findings were reviewed. Dynamic CTA findings were correlated to available prior conventional CTA and contrasted-enhanced ultrasound (CEUS). The dynamic protocols were individualized for each patient accordingly with previous knowledge of size, location, and flow rate of the endoleak, patient’s weight, and bolus timing in prior injections to estimate optimal timing of image acquisition.

Results:
There were a total of 14 patients (10 men, 4 women; average age 75.9 ± 10.3 years; range 51–88 years). The average time since the initial procedure was 3.5 ± 2.7 years (range 6 months–8.5 years). Nine (64%) patients had a single source of endoleak, and five (36%) patients had two separate sources of endoleak, with a total of 19 sources of endoleak. Twelve (63%) of the 19 leaks were type II, four (21%) were type IA, and three (16%) were type III. Eleven (92%) of the 12 type-II endoleaks were from lumbar arteries and one (8%) was from inferior mesenteric artery. Of the four type-IA endoleaks, one was at the level of a renal stent after endovascular infrarenal aneurysm repair using a suprarenal fixation device and renal stent; one was adjacent to the overlapping stent in the proximal descending aorta; one from posterior proximal aortic fixation; and one from proximal iliac stent fixation. Of the three type-III endoleaks, one was related to a fractured superior mesenteric artery stent; one from the left iliac limb defect; and one from right iliac component defect. Five (36%) of the 14 patients had new repair procedure and two (14%) additional patients were advised for new repair but surgery was contraindicated due to other comorbidities; seven (50%) patients had conservative treatment with follow up images.

Conclusion:
Dynamic CTA has an important role in imaging after endovascular aneurysm repair (EVAR) by providing detailed time-resolved anatomy essential to characterize and plan treatment of different types of endoleak.