An Overview of Multimodality Detection of Endoleaks and Their Specific Treatment Based on Subtype Present

This submission has open access
Submission ID :
GEST2021-121
Submission Type
Submission Topic
Purpose :
The purpose of this exhibit is to review the different types of endoleaks using original schematics and illustrations, refresh relevant anatomy, explore a multimodality approach to surveillance and diagnosis of endoleaks, and discuss the varied treatment of endoleaks based on the specific subtype.
Materials & Methods :
Thoracic or abdominal aortic aneurysms are repaired via an endovascular approach (TVAR or EVAR), which involves the deployment of a stent-graft, or endoprosthesis, in the aneurysm sac to prevent aneurysmal evolution or rupture. As with any prosthesis, there are risks involved. In this case, leakage of blood around the graft (endoleak) has been reported in up to 30% of cases. Five distinct types of endoleaks have been defined, all with their own characteristics of blood flow. The surveillance and detection of endoleaks is best done via a multimodality approach using radiography, CT imaging, MR imaging, and nuclear radiology. Each modality uses a different approach and has its own benefits.
Management of endoleaks depends on the subtype detected. For example, Type 1 endoleak involves leakage of blood around the stent via the proximal or distal attachment sites (1A vs 1B), and is best managed by balloon angioplasty or the deployment of additional stents to cover the proximal or distal endpoints. Conversely, Type 2 endoleak involves blood filling the space around the stent via tributaries of the aorta, such as the lumbar or intercostal arteries. Unlike Type 1 endoleak, an expanding Type 2 endoleak by greater than 5 mm requires immediate embolization of the feeding vessels in order to decrease the external pressures on the endoprosthesis and prevent stent failure. The differences in management can be expanded to all five subtypes of endoleaks, and therefore it is imperative to recognize the correct endoleak on surveillance imaging.
Results :
This educational exhibit will first review relevant anatomy of the thoracic and abdominal aorta and correctly define aneurysm and ectasia as it relates to the segmental vascular anatomy. Then, different graft materials will be outlined, and subtypes of endoleaks will be defined using radiography, CT, MR, and nuclear radiology. Lastly, treatment of the different subtypes of endoleaks will be explored with relevant and important considerations indicated.
Conclusions :
It is important for interventionalists to recognize different types of endoleaks using a multimodality approach, as treatment is varied depending on the subtype of endoleak present.
Poster Abstract :
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Radiology Resident
,
SUNY Upstate Medical University
SUNY Upstate Medical University
SUNY Upstate Medical University
SUNY Upstate Medical University
SUNY Upstate Medical University

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