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Intrasac flow velocities predict sealing of type II endoleaks after endovascular abdominal aortic aneurysm repair.

AbstractPURPOSE:
The purpose of this study was to determine whether intrasac spectral Doppler flow velocities can predict whether or not a type II endoleak will spontaneously seal and to relate intrasac flow to preoperative branch vessel anatomy.
METHODS:
Between October 1996 and June 2002, 265 patients with abdominal aortic aneurysms underwent endovascular repair. Patients with less than 24 months of follow-up and type I endoleaks were excluded. Type II endoleaks were confirmed with duplex scan and computed tomographic angiography. Two groups were identified: 14 patients with sealed endoleaks (<6 months) without intervention and 16 patients with persistent endoleaks greater than 6 months and without resolution. Spectral Doppler flow velocities were recorded from endoleaks within the aneurysm sac.
RESULTS:
The two groups were similar in age, demographics, and aneurysm morphology. The mean follow-up times were 29.9 +/- 7.9 months for sealed endoleaks and 30.2 +/- 8.6 months for persistent endoleaks (P = not significant). Spectral Doppler velocities were significantly lower in patients with sealed endoleaks compared with persistent endoleaks (75.5 +/- 78.8 cm/s versus 138.2 +/- 36.2 cm/s; P <.01). Patients with sealed endoleaks and low (<100 cm/s) intrasac Doppler velocities had significantly fewer patent inferior mesenteric arteries (43% versus 81%; P <.01), a smaller inferior mesenteric artery (5.6 +/- 1.8 mm versus 7.2 +/- 1.3 mm; P <.01), and fewer paired lumbar arteries (1.3 +/- 0.8 versus 2.4 +/- 0.6; P <.0001) compared with those with persistent endoleaks and high (>100 cm/s) intrasac flow velocities. Three patients with sealed endoleaks had Doppler velocities of 200 cm/s or greater. However, the diameter of the inferior mesenteric artery in these patients was 4 mm or less with no visualized lumbar arteries before surgery. Aneurysm diameter(-4.6 +/- 5.6 mm) and volume (-0.9 +/- 45.2 mL) decreased in patients with sealed endoleaks. Aneurysm diameter (1.8 +/- 4.9 mm) and volume (18.5 +/- 33.9 mL) increased slightly in patients with persistent endoleaks (P <.05). No ruptures or conversions occurred in any patient. Secondary interventions to treat type II endoleaks were unsuccessful in six of 16 patients (38%) with persistent endoleaks.
CONCLUSION:
Intrasac Doppler velocities can be used to predict whether a type II endoleak will spontaneously seal. High-velocity type II endoleaks are related to preoperative large branch vessel diameter and number and are resistant to endovascular treatment.
AuthorsFrank R Arko, Konstantinos A Filis, Scott A Siedel, Bonnie L Johnson, Angelia R Drake, Thomas J Fogarty, Christopher K Zarins
JournalJournal of vascular surgery (J Vasc Surg) Vol. 37 Issue 1 Pg. 8-15 (Jan 2003) ISSN: 0741-5214 [Print] United States
PMID12514572 (Publication Type: Journal Article)
Topics
  • Aortic Aneurysm, Abdominal (complications, therapy, ultrasonography)
  • Blood Flow Velocity
  • Follow-Up Studies
  • Humans
  • Prognosis
  • Stents
  • Ultrasonography, Doppler

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