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Semin intervent Radiol 2020; 37(04): 356-364
DOI: 10.1055/s-0040-1715882
Review Article

Surveillance Imaging following Endovascular Aneurysm Repair: State of the Art

Stephanie H. Kim
1   Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Harold I. Litt
1   Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract

Endovascular aneurysmal repair (EVAR) has become a prominent modality for the treatment of abdominal aortic aneurysm. Surveillance imaging is important for the detection of device-related complications, which include endoleak, structural abnormalities, and infection. Currently used modalities include ultrasound, X-ray, computed tomography, magnetic resonance imaging, and angiography. Understanding the advantages and drawbacks of each modality, as well available guidelines, can guide selection of the appropriate technique for individual patients. We review complications following EVAR and advances in surveillance imaging modalities.

Keywords

abdominal aortic aneurysm - endovascular aneurysm repair - surveillance imaging - endoleak - interventional radiology


Publication History

Article published online:
01 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
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  • References

  • 1 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5 (06) 491-499
    CrossrefPubMedGoogle Scholar
  • 2 Teufelsbauer H, Prusa AM, Wolff K. , et al. Endovascular stent grafting versus open surgical operation in patients with infrarenal aortic aneurysms: a propensity score-adjusted analysis. Circulation 2002; 106 (07) 782-787
    CrossrefPubMedGoogle Scholar
  • 3 Powell JT, Sweeting MJ, Ulug P. , et al; EVAR-1, DREAM, OVER and ACE Trialists. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg 2017; 104 (03) 166-178
    CrossrefPubMedGoogle Scholar
  • 4 Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 2008; 358 (05) 464-474
    CrossrefPubMedGoogle Scholar
  • 5 Nordon IM, Karthikesalingam A, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Secondary interventions following endovascular aneurysm repair (EVAR) and the enduring value of graft surveillance. Eur J Vasc Endovasc Surg 2010; 39 (05) 547-554
    CrossrefPubMedGoogle Scholar
  • 6 Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. United Kingdom EVAR Trial Investigators. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med 2010; 362 (20) 1872-1880
    CrossrefPubMedGoogle Scholar
  • 7 Brown LC, Greenhalgh RM, Powell JT, Thompson SG. EVAR Trial Participants. Use of baseline factors to predict complications and reinterventions after endovascular repair of abdominal aortic aneurysm. Br J Surg 2010; 97 (08) 1207-1217
    CrossrefPubMedGoogle Scholar
  • 8 Karthikesalingam A, Holt PJ, Hinchliffe RJ, Nordon IM, Loftus IM, Thompson MM. Risk of reintervention after endovascular aortic aneurysm repair. Br J Surg 2010; 97 (05) 657-663
    CrossrefPubMedGoogle Scholar
  • 9 Golledge J, Parr A, Boult M, Maddern G, Fitridge R. The outcome of endovascular repair of small abdominal aortic aneurysms. Ann Surg 2007; 245 (02) 326-333
    CrossrefPubMedGoogle Scholar
  • 10 Drury D, Michaels JA, Jones L, Ayiku L. Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg 2005; 92 (08) 937-946
    CrossrefPubMedGoogle Scholar
  • 11 Görich J, Rilinger N, Sokiranski R. , et al. Treatment of leaks after endovascular repair of aortic aneurysms. Radiology 2000; 215 (02) 414-420
    CrossrefPubMedGoogle Scholar
  • 12 White GH, Yu W, May J. Endoleak--a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg 1996; 3 (01) 124-125
    CrossrefPubMedGoogle Scholar
  • 13 Lal BK, Zhou W, Li Z. , et al; OVER Veterans Affairs Cooperative Study Group. Predictors and outcomes of endoleaks in the Veterans Affairs Open Versus Endovascular Repair (OVER) trial of abdominal aortic aneurysms. J Vasc Surg 2015; 62 (06) 1394-1404
    CrossrefPubMedGoogle Scholar
  • 14 Tan TW, Eslami M, Rybin D, Doros G, Zhang WW, Farber A. Outcomes of patients with type I endoleak at completion of endovascular abdominal aneurysm repair. J Vasc Surg 2016; 63 (06) 1420-1427
    CrossrefPubMedGoogle Scholar
  • 15 Yeung JJ, Hernandez-Boussard TM, Song TK, Dalman RL, Lee JT. Preoperative thrombus volume predicts sac regression after endovascular aneurysm repair. J Endovasc Ther 2009; 16 (03) 380-388
    CrossrefPubMedGoogle Scholar
  • 16 Ueda T, Takaoka H, Petrovitch I, Rubin GD. Detection of broken sutures and metal-ring fractures in AneuRx stent-grafts by using three-dimensional CT angiography after endovascular abdominal aortic aneurysm repair: association with late endoleak development and device migration. Radiology 2014; 272 (01) 275-283
    CrossrefPubMedGoogle Scholar
  • 17 Aburahma AF, Campbell JE, Mousa AY. , et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg 2011; 54 (01) 13-21
    CrossrefPubMedGoogle Scholar
  • 18 Mascoli C, Faggioli G, Gallitto E. , et al. Planning and endograft related variables predisposing to late distal Type I endoleaks. Eur J Vasc Endovasc Surg 2019; 58 (03) 334-342
    CrossrefPubMedGoogle Scholar
  • 19 Guo Q, Du X, Zhao J. , et al. Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: a meta-analysis. PLoS One 2017; 12 (02) e0170600
    CrossrefPubMedGoogle Scholar
  • 20 Sheehan MK, Ouriel K, Greenberg R. , et al. Are type II endoleaks after endovascular aneurysm repair endograft dependent?. J Vasc Surg 2006; 43 (04) 657-661
    CrossrefPubMedGoogle Scholar
  • 21 Avgerinos ED, Chaer RA, Makaroun MS. Type II endoleaks. J Vasc Surg 2014; 60 (05) 1386-1391
    CrossrefPubMedGoogle Scholar
  • 22 Nolz R, Teufelsbauer H, Asenbaum U. , et al. Type II endoleaks after endovascular repair of abdominal aortic aneurysms: fate of the aneurysm sac and neck changes during long-term follow-up. J Endovasc Ther 2012; 19 (02) 193-199
    CrossrefPubMedGoogle Scholar
  • 23 Güntner O, Zeman F, Wohlgemuth WA. , et al. Inferior mesenteric arterial type II endoleaks after endovascular repair of abdominal aortic aneurysm: are they predictable?. Radiology 2014; 270 (03) 910-919
    CrossrefPubMedGoogle Scholar
  • 24 Maleux G, Poorteman L, Laenen A. , et al. Incidence, etiology, and management of type III endoleak after endovascular aortic repair. J Vasc Surg 2017; 66 (04) 1056-1064
    CrossrefPubMedGoogle Scholar
  • 25 Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewijk C, Laheij RJ. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg 2000; 32 (04) 739-749
    CrossrefPubMedGoogle Scholar
  • 26 Toya N, Fujita T, Kanaoka Y, Ohki T. Endotension following endovascular aneurysm repair. Vasc Med 2008; 13 (04) 305-311
    CrossrefPubMedGoogle Scholar
  • 27 Hobo R, Buth J. EUROSTAR Collaborators. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. J Vasc Surg 2006; 43 (05) 896-902
    CrossrefPubMedGoogle Scholar
  • 28 Carpenter JP, Anderson WN, Brewster DC. , et al; Lifepath Investigators. Multicenter pivotal trial results of the Lifepath System for endovascular aortic aneurysm repair. J Vasc Surg 2004; 39 (01) 34-43
    CrossrefPubMedGoogle Scholar
  • 29 Carroccio A, Faries PL, Morrissey NJ. , et al. Predicting iliac limb occlusions after bifurcated aortic stent grafting: anatomic and device-related causes. J Vasc Surg 2002; 36 (04) 679-684
    CrossrefPubMedGoogle Scholar
  • 30 Kratzberg JA, Golzarian J, Raghavan ML. Role of graft oversizing in the fixation strength of barbed endovascular grafts. J Vasc Surg 2009; 49 (06) 1543-1553
    CrossrefPubMedGoogle Scholar
  • 31 Skibba AA, Evans JR, Greenfield DT. , et al. Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms. J Vasc Surg 2015; 62 (04) 868-875
    CrossrefPubMedGoogle Scholar
  • 32 Maleux G, Koolen M, Heye S, Nevelsteen A. Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts. J Vasc Interv Radiol 2008; 19 (10) 1409-1412
    CrossrefPubMedGoogle Scholar
  • 33 Møller LB, Kaufman J, Verland S. , et al. Variations in the cytoplasmic region account for the heterogeneity of the chicken MHC class I (B-F) molecules. Immunogenetics 1991; 34 (02) 110-120
    CrossrefPubMedGoogle Scholar
  • 34 Mantas GK, Antonopoulos CN, Sfyroeras GS. , et al. Factors predisposing to endograft limb occlusion after endovascular aortic repair. Eur J Vasc Endovasc Surg 2015; 49 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 35 Niaz OS, Rao A, Abidia A, Parrott R, Refson J, Somaiya P. Surgical and medical interventions for abdominal aortic graft infections. Cochrane Database Syst Rev 2019; (11) CD013469
    PubMedGoogle Scholar
  • 36 Post ICJH, Vos CG. Systematic review and meta-analysis on the management of open abdominal aortic graft infections. Eur J Vasc Endovasc Surg 2019; 58 (02) 258-281
    CrossrefPubMedGoogle Scholar
  • 37 Hughes FM, Kavanagh D, Barry M, Owens A, MacErlaine DP, Malone DE. Aortoenteric fistula: a diagnostic dilemma. Abdom Imaging 2007; 32 (03) 398-402
    CrossrefPubMedGoogle Scholar
  • 38 Fearn S, Lawrence-Brown MM, Semmens JB, Hartley D. Follow-up after endovascular aortic aneurysm repair: the plain radiograph has an essential role in surveillance. J Endovasc Ther 2003; 10 (05) 894-901
    CrossrefPubMedGoogle Scholar
  • 39 Harrison GJ, Oshin OA, Vallabhaneni SR, Brennan JA, Fisher RK, McWilliams RG. Surveillance after EVAR based on duplex ultrasound and abdominal radiography. Eur J Vasc Endovasc Surg 2011; 42 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 40 Chaikof EL, Dalman RL, Eskandari MK. , et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67 (01) 2-77.e2
    CrossrefPubMedGoogle Scholar
  • 41 Bobadilla JL, Suwanabol PA, Reeder SB, Pozniak MA, Bley TA, Tefera G. Clinical implications of non-contrast-enhanced computed tomography for follow-up after endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2013; 27 (08) 1042-1048
    CrossrefPubMedGoogle Scholar
  • 42 Armerding MD, Rubin GD, Beaulieu CF. , et al. Aortic aneurysmal disease: assessment of stent-graft treatment-CT versus conventional angiography. Radiology 2000; 215 (01) 138-146
    CrossrefPubMedGoogle Scholar
  • 43 Iezzi R, Cotroneo AR, Filippone A. , et al. Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection?. Radiology 2006; 241 (03) 915-921
    CrossrefPubMedGoogle Scholar
  • 44 Macari M, Chandarana H, Schmidt B, Lee J, Lamparello P, Babb J. Abdominal aortic aneurysm: can the arterial phase at CT evaluation after endovascular repair be eliminated to reduce radiation dose?. Radiology 2006; 241 (03) 908-914
    CrossrefPubMedGoogle Scholar
  • 45 Wintersperger B, Jakobs T, Herzog P. , et al. Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 2005; 15 (02) 334-341
    CrossrefPubMedGoogle Scholar
  • 46 Winklehner A, Gordic S, Lauk E. , et al. Automated attenuation-based tube voltage selection for body CTA: performance evaluation of 192-slice dual-source CT. Eur Radiol 2015; 25 (08) 2346-2353
    CrossrefPubMedGoogle Scholar
  • 47 Geyer LL, Schoepf UJ, Meinel FG. , et al. State of the art: iterative CT reconstruction techniques. Radiology 2015; 276 (02) 339-357
    CrossrefPubMedGoogle Scholar
  • 48 Hansen NJ, Kaza RK, Maturen KE, Liu PS, Platt JF. Evaluation of low-dose CT angiography with model-based iterative reconstruction after endovascular aneurysm repair of a thoracic or abdominal aortic aneurysm. AJR Am J Roentgenol 2014; 202 (03) 648-655
    CrossrefPubMedGoogle Scholar
  • 49 Flors L, Leiva-Salinas C, Norton PT, Patrie JT, Hagspiel KD. Endoleak detection after endovascular repair of thoracic aortic aneurysm using dual-source dual-energy CT: suitable scanning protocols and potential radiation dose reduction. AJR Am J Roentgenol 2013; 200 (02) 451-460
    CrossrefPubMedGoogle Scholar
  • 50 Javor D, Wressnegger A, Unterhumer S. , et al. Endoleak detection using single-acquisition split-bolus dual-energy computer tomography (DECT). Eur Radiol 2017; 27 (04) 1622-1630
    CrossrefPubMedGoogle Scholar
  • 51 Dangelmaier J, Bar-Ness D, Daerr H. , et al. Experimental feasibility of spectral photon-counting computed tomography with two contrast agents for the detection of endoleaks following endovascular aortic repair. Eur Radiol 2018; 28 (08) 3318-3325
    CrossrefPubMedGoogle Scholar
  • 52 Leng S, Bruesewitz M, Tao S. , et al. Photon-counting detector CT: system design and clinical applications of an emerging technology. Radiographics 2019; 39 (03) 729-743
    CrossrefPubMedGoogle Scholar
  • 53 Pourmorteza A, Symons R, Sandfort V. , et al. Abdominal imaging with contrast-enhanced photon-counting CT: first human experience. Radiology 2016; 279 (01) 239-245
    CrossrefPubMedGoogle Scholar
  • 54 Davenport MS, Perazella MA, Yee J. , et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 294 (03) 660-668
    CrossrefPubMedGoogle Scholar
  • 55 Rudnick MR, Leonberg-Yoo AK, Litt HI, Cohen RM, Hilton S, Reese PP. The controversy of contrast-induced nephropathy with intravenous contrast: What is the risk?. Am J Kidney Dis 2020; 75 (01) 105-113
    CrossrefPubMedGoogle Scholar
  • 56 Weisbord SD, Gallagher M, Jneid H. , et al; PRESERVE Trial Group. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 2018; 378 (07) 603-614
    CrossrefPubMedGoogle Scholar
  • 57 Resta EC, Secchi F, Giardino A. , et al. Non-contrast MR imaging for detecting endoleak after abdominal endovascular aortic repair. Int J Cardiovasc Imaging 2013; 29 (01) 229-235
    CrossrefPubMedGoogle Scholar
  • 58 Salehi Ravesh M, Langguth P, Pfarr JA. , et al. Non-contrast-enhanced magnetic resonance imaging for visualization and quantification of endovascular aortic prosthesis, their endoleaks and aneurysm sacs at 1.5 T. Magn Reson Imaging 2019; 60: 164-172
    CrossrefPubMedGoogle Scholar
  • 59 Habets J, Zandvoort HJ, Reitsma JB. , et al. Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 2013; 45 (04) 340-350
    CrossrefPubMedGoogle Scholar
  • 60 Hartung MP, Grist TM, François CJ. Magnetic resonance angiography: current status and future directions. J Cardiovasc Magn Reson 2011; 13: 19
    CrossrefPubMedGoogle Scholar
  • 61 Barth MM, Smith MP, Pedrosa I, Lenkinski RE, Rofsky NM. Body MR imaging at 3.0 T: understanding the opportunities and challenges. Radiographics 2007; 27 (05) 1445-1462 , discussion 1462–1464
    CrossrefPubMedGoogle Scholar
  • 62 Katahashi K, Sano M, Takehara Y. , et al. Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis. J Vasc Surg 2019; 70 (01) 107-116.e1
    CrossrefPubMedGoogle Scholar
  • 63 Sakata M, Takehara Y, Katahashi K. , et al. Hemodynamic analysis of endoleaks after endovascular abdominal aortic aneurysm repair by using 4-dimensional flow-sensitive magnetic resonance imaging. Circ J 2016; 80 (08) 1715-1725
    CrossrefPubMedGoogle Scholar
  • 64 Muthalaly RG, Nerlekar N, Ge Y, Kwong RY, Nasis A. MRI in patients with cardiac implantable electronic devices. Radiology 2018; 289 (02) 281-292
    CrossrefPubMedGoogle Scholar
  • 65 Mathur M, Jones JR, Weinreb JC. Gadolinium deposition and nephrogenic systemic fibrosis: a radiologist's primer. Radiographics 2020; 40 (01) 153-162
    CrossrefPubMedGoogle Scholar
  • 66 Merkle EM, Klein S, Krämer SC, Wisianowsky C. MR angiographic findings in patients with aortic endoprostheses. AJR Am J Roentgenol 2002; 178 (03) 641-648
    CrossrefPubMedGoogle Scholar
  • 67 Kakeda S, Korogi Y, Hiai Y. , et al. MRA of intracranial aneurysms embolized with platinum coils: a vascular phantom study at 1.5T and 3T. J Magn Reson Imaging 2008; 28 (01) 13-20
    CrossrefPubMedGoogle Scholar
  • 68 Sprouse II LR, Meier III GH, Parent FN, DeMasi RJ, Glickman MH, Barber GA. Is ultrasound more accurate than axial computed tomography for determination of maximal abdominal aortic aneurysm diameter?. Eur J Vasc Endovasc Surg 2004; 28 (01) 28-35
    CrossrefPubMedGoogle Scholar
  • 69 Abraha I, Luchetta ML, De Florio R. , et al. Ultrasonography for endoleak detection after endoluminal abdominal aortic aneurysm repair. Cochrane Database Syst Rev 2017; 6: CD010296
    CrossrefPubMedGoogle Scholar
  • 70 Harky A, Zywicka E, Santoro G, Jullian L, Joshi M, Dimitri S. Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis. J Ultrasound 2019; 22 (01) 65-75
    CrossrefPubMedGoogle Scholar
  • 71 Karanikola E, Dalainas I, Karaolanis G, Zografos G, Filis K. Duplex ultrasound versus computed tomography for the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Where do we stand now?. Int J Angiol 2014; 23 (03) 155-164
    Article in Thieme ConnectPubMedGoogle Scholar
  • 72 Stavropoulos SW, Clark TW, Carpenter JP. , et al. Use of CT angiography to classify endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 2005; 16 (05) 663-667
    CrossrefPubMedGoogle Scholar
  • 73 Barbetta I, van den Berg JC. Access and hemostasis: femoral and popliteal approaches and closure devices-why, what, when, and how?. Semin Intervent Radiol 2014; 31 (04) 353-360
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 White SB, Stavropoulos SW. Management of endoleaks following endovascular aneurysm repair. Semin Intervent Radiol 2009; 26 (01) 33-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 75 Shah A, Stavropoulos SW. Imaging surveillance following endovascular aneurysm repair. Semin Intervent Radiol 2009; 26 (01) 10-16
    Article in Thieme ConnectPubMedGoogle Scholar