Type 2 endoleaks in endovascular aortic repair: cone beam CT and automatic vessel detection to guide the embolization

Abstract

Background

Dual-phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software are helpful tools for detecting arteries before planned endovascular interventions.

Purpose

To evaluate the usefulness of DP-CBCT and AVD software in guiding the trans-arterial embolization (TAE) of challenging T2 lumbar endoleaks (T2-L-EL).

Material and Methods

Ten patients with T2-L-EL were included in this study. The accuracy of DP-CBCT and the AVD software was defined by the ability to detect the endoleak and arterial feeding vessel, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software and the successful embolization of the endoleak. Clinical success was defined as the absence of recurrent endoleaks during follow-up and the stability of the sac diameter for persistent endoleaks. The total volume of iodinated contrast medium, overall procedure time, mean procedural radiation dose, and mean fluoroscopy time were recorded.

Results

The EL was detected by DP-CBCT in all patients. The AVD software identified the feeding arterial branch in all cases. In one patient, the nidus of the endoleak was not reached due to the small caliber of the feeding artery, even though the software had clearly identified the vessel route. The mean contrast volume was 109 mL, the mean overall procedural time was 74.3 min. The mean procedural radiation dose was 140.97 Gy cm², and the mean fluoroscopy time was 29.8 min.

Conclusion

The use of DP-CBCT and the AVD software is feasible and may facilitate successful embolization in challenging occult T2-L-EL with complex vasculature.

Keywords

Cone beam computed tomography (CBCT)automatic vessel detection software trans-arterial embolization type 2 lumbar endoleaks

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References

Gelfand

White

Wilson

. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 2006; 20: 69–74.

Schanzer

Greenberg

Hevelone

et al.

Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011; 123: 2848–2855.

Bryce

Rogoff

Romanelli

et al.

Endovascular Repair of Abdominal Aortic Aneurysms: Vascular Anatomy, Device Selection, Procedure, and Procedure-specific Complications. Radiographics 2015; 35: 593–615.

Rand

Uberoi

Cil

et al.

Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 2013; 36: 35–45.

Avgerinos

Chaer

Makaroun

. Type II endoleaks. J Vasc Surg 2014; 60: 1386–1391.

Van den Berg

. Update on new tools for three-dimensional navigation in endovascular procedures. Aorta (Stamford) 2014; 2: 279–285.

Angle

. Cone-beam CT: vascular applications. Tech Vasc Interv Radiol 2013; 16: 144–149.

Pichon

Bekes

Deshamps

et al.

Development and preliminary evaluation of software for planning selective liver embolizations from three-dimensional rotational fluoroscopy imaging. Int J Comput Assist Radiol Surg 2008; 3: 405–412.

Chaikof

Blankensteijn

Harris

et al.

Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of The Society for Vascular Surgery/American Association for Vascular Surgery. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 2002; 35: 1048–1060.

10.

Miyayama

Yamashiro

Okuda

et al.

Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography. Cardiovasc Intervent Radiol 2009; 32: 255–264.

11.

Ronot

Abdel-Rehim

Hakimé

et al.

Cone-beam CT angiography for determination of tumor-feeding vessels during chemoembolization of liver tumors: comparison of conventional and dedicated-software analysis. J Vasc Interv Radiol 2016; 27: 32–38.

12.

Tacher

Radaelli

Lin

et al.

How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology 2015; 274: 320–334.

13.

Iwazawa

Ohueo

Hashimoto

et al.

Feasibility of using vessel-detection software for the endovascular treatment of visceral arterial bleeding. Diagn Interv Radiol 2014; 20: 160–163.

14.

Lee

Chung

Yin

et al.

Cone-beam computed tomography (CBCT) hepatic arteriography in chemoembolization for hepatocellular carcinoma: performance depicting tumors and tumor feeders. Cardiovasc Intervent Radiol 2015; 38: 1218–1230.

15.

Carrafiello

Ierardi

Duka

et al.

Usefulness of cone-beam computed tomography and automatic vessel detection software in emergency transarterial embolization. Cardiovasc Intervent Radiol 2016; 39: 530–537.

16.

Chiaradia

Radaelli

Campeggi

et al.

Automatic three-dimensional detection of prostatic arteries using cone-beam CT during prostatic arterial embolization. J Vasc Interv Radiol 2015; 26: 413–417.

17.

Millen

Canavati

Harrison

et al.

Defining a role for contrast-enhanced ultrasound in endovascular aneurysm repair surveillance. J Vasc Surg 2013; 58: 18–23.

18.

Bredahl

Taudorf

Lonn

et al.

Contrast enhanced ultrasound can replace computed tomography angiography for surveillance after endovascular aortic aneurysm repair. Eur J Vasc Endovasc Surg 2016; 52: 729–734.

19.

Kasirajan

Matteson

Marek

et al.

Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg 2003; 38: 61–66.

20.

Nevala

Biancari

Manninen

et al.

Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol 2010; 33: 278–284.

21.

Patil

Fischman

Patel

et al.

GI hemorrhage arising from splenic artery: intraprocedure cone-beam CT as problem-solving tool to aide in safe catheterization of offending vessel. Clin Imaging 2015; 39: 928–930.

22.

Carrafiello

Ierardi

Radaelli

et al.

Unenhanced cone beam computed tomography and fusion imaging in direct percutaneous sac injection for treatment of type II endoleak: technical note. Cardiovasc Intervent Radiol 2016; 39: 447–452.

23.

Ierardi

Duka

Radaelli

et al.

Fusion of CT angiography or MR angiography with unenhanced CBCT and fluoroscopy guidance in endovascular treatments of aorto-iliac steno-occlusion: technical note on a preliminary experience. Cardiovasc Intervent Radiol 2016; 39: 111–116.

24.

Dias

Billberg

Sonesson

et al.

The effects of combining fusion imaging, low-frequency pulsed fluoroscopy, and low-concentration contrast agent during endovascular aneurysm repair. J Vasc Surg 2016; 63: 1147–1155.