Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms

Abstract

Purpose: An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR).

Materials and Methods: Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n = 80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n = 50). Statistical analysis comprised a univariate and multivariate analysis.

Results: Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4 ± 3.8 mm; HRG 23.6 ± 2.5 mm; p = 0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7 ± 18.0 %; HRG 25.3 ± 17.5 %; p = 0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3 %; HRG 92.0 %; p = 0.003) and their diameter (LRG 3.3 ± 0.7 mm; HRG 3.8 ± 0.9 mm; p = 0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7 ± 1.4; HRG 3.6 ± 1.2; univariate: p = 0.01; multivariate: p = 0.006) as well as their diameter (LRG 2.1 ± 0.4 mm; HRG 2.4 ± 0.4 mm; univariate: p < 0.001; multivariate: p = 0.006) were highly significantly associated with the development of type 2 endoleaks of the HRG.

Conclusion: The most important predictive factors for the development of high-risk type 2 endoleaks were mainly the number and the diameter of the LAs which perfused the AAA.

Key Points:

• This study is a very detailed and comprehensive analysis of the value of various CT parameters as potential predictors of the clinical outcome of type 2 endoleaks after EVAR.

• Anatomical as well as thrombus-specific parameters were unsuitable as predictors.

• The most important predictive factors were mainly the number and the diameter of the LAs which perfused the AAA.

Citation Format:

• Löwenthal D., Herzog L., Rogits B. et al. Identification of Predictive CT Angiographic Factors in the Development of High-Risk Type 2 Endoleaks after Endovascular Aneurysm Repair in Patients with Infrarenal Aortic Aneurysms. Fortschr Röntgenstr 2015; 187: 49 – 55

Zusammenfassung

Ziel: Eine umfängliche Analyse zur Wertigkeit computertomografischer (CT) Parameter als potenzielle Prädiktoren des klinischen Verlaufs von Typ-2 Endoleaks nach endovaskulärem Aortenrepair (EVAR).

Material und Methoden: Retrospektiv wurden die präoperativen CT-Angiografien von 130 Patienten mit einem infrarenalen Bauchaortenaneurysma (BAA) ausgewertet. Anhand postoperativer CT und angiografischer Verlaufskontrollen wurden die Patienten einer Niedrigrisikogruppe (NRG; ohne bzw. mit transientem Typ-2 Endoleak; n = 80) oder einer Hochrisikogruppe (HRG; mit persistentem bzw. behandlungsbedürftigem Typ-2 Endoleak; n = 50) zugeordnet. Die statistische Auswertung umfasste eine univariate und multivariate Analyse.

Ergebnisse: Anhand der initialen CT wurden anatomische, thrombusspezifische und Parameter zu aortalen Seitästen beurteilt. Bei den anatomischen Parametern fand sich lediglich für den Durchmesser der unmittelbar infrarenalen Aorta ein signifikanter Unterschied in der univariaten Analyse (NRG 22,4 ± 3,8 mm; HRG 23,6 ± 2,5 mm; p = 0,03). Die Betrachtung thrombusspezifischen Parameter zeigte für die relative Thrombusfläche einen Trend zur Signifikanz (NRG 31,7 ± 18,0 %; HRG 25,3 ± 17,5 %; p = 0,09). Hinsichtlich der aortalen Seitäste waren die Offenheit der Arteria mesenterica inferior (NRG 71,3 %; HRG 92,0 %; p = 0,003) und deren Durchmesser (NRG 3,3 ± 0,7 mm; HRG 3,8 ± 0,9 mm; p = 0,004) lediglich univariat signifikant unterschiedlich. Demgegenüber waren sowohl Anzahl der Lumbalarterien (LA; NRG 2,7 ± 1,4; HRG 3,6 ± 1,2; univariat: p = 0,01; multivariat: p = 0,006) sowie deren Durchmesser (NRG 2,1 ± 0,4 mm; HRG 2,4 ± 0,4 mm; univariat: p < 0,001; multivariat: p = 0,006) hochsignifikant mit der Entstehung eines Hochrisikotyp-2 Endoleaks assoziiert.

Schlussfolgerung: Als bedeutendste prädiktive Faktoren für die Entstehung eines Hochrisikotyp-2 Endoleaks fanden sich die Anzahl als auch der Durchmesser der perfundierten aneurysmaspeisenden LA.

Key words

aorta - CT angiography - aneurysm

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