CTMS in the study of post-EVAR endoleak in the treatment of aneurysmal dilations

Computed tomography angiography (CTA) has been widely used in diagnostic evaluation of many aortic diseases, but there are not standardized techniques for aortic CTA. The purpose of this study is to compare two methods: biphasic technique and split bolus. A 64-slice CT scanner has been used. There were a total of 28 patients involved in the study. The patients have been divided in two groups: - Group A: 18 patients - Group B: 10 patients The biphasic technique has been used on 18 patients in group A. In this protocol was used a low dose acquisition without contrast medium (CM) and two contrastographic phases with CM. The split bolus technique was performed on 10 patients of group B. 120-140 ml of CM are divided in two boluses. The first bolus of 55-90 ml of CM was injected at a flow of 1,5-2 ml/s, followed by 20ml of physiological solution at a flow of 1,5-2ml/s. After physiological solution the second bolus of 35-60 ml was injected at a flow of 3,5ml/s followed by 20ml of Nacl at a flow of 3,5ml/s. In group A 6 patients had endoleak type I, n=2 endoleak type II, n=8 endoleak type III, n=2 endoleak type IV. (dose of 43.2 mSv). In group B 2 patients had endoleak type I, n= 4 endoleak type II, n=3 endoleak type III and n=1 endoleak type IV. (dose of 16,39 mSv). The biphasic technique has high spatial resolution and contrast resolution, reduction of acquisition times and reduction of artifacts, but an unacceptable a great amount of radiation is involved. The split bolus technique provides results comparable to the biphasic technique but with a lower dose of radiation.

Laser-assisted transprosthesial coil embolization combined with thrombin injection for treatment of an endoleak type II after endovascular aneurysm repair

The treatment of endoleaks type II had to be adapted to the anatomy of each individual patient. The laser-assisted perforation of the prosthesis can be an easier method to reach the aneurysm sac directly than using transarterial or translumbar approaches.

Early experience with the new endovascular aneurysm sealing system Nellix: First clinical results after 50 implantations

Objective In the present study, 50 EVAS procedures were evaluated in regard to primary (survival and technical success) and secondary (device-related complications) events of interest. Methods The single center study was conducted from July 2013 to August 2014 with prospective collection of the clinical data. The clinical results were controlled by CT angiography and contrast-enhanced ultrasound . Results The technical success was 98% and the 30-day mortality 4%. One (2%) patient died from multisystem organ failure and another patient from an intracranial bleeding, respectively. One patient (2%) suffered from a device-related aneurysm rupture. During early follow-up, one (2%) patient developed an endoleak type II, while three (6%) patients suffered from a partial endograft limb thrombosis. Overall, a secondary intervention was necessary in six (12%) patients. Conclusions With the Nellix EVAS system, a high primary technical success of 98% was achieved; one (2%) patient developed an endoleak type II which did not require secondary intervention. Those promising results are contrasted by a substantial rate of endograft limb thromboses (8%) and one (2%) intraoperative aneurysm rupture. Further studies are needed to assess the durability of the Nellix stentgraft and the occurrence of device-related complications.

The use of Doppler ultrasonography for pre- and post-surgery monitoring of abdominal aortic aneurysm. Case report.

A 75 year old male patient was monitored for 3 years by Doppler Ultrasonography (US) for an abdominal aorta aneurysm (AAA). Because the aneurysm increased significantly, an aortic prosthesis was installed via an endovascular procedure. After one month of post-surgery monitoring, both Doppler US exam and contrast enhancement US (CEUS) suspected the presence of a leak at the level of the prosthesis. A new surgical procedure was scheduled and intraoperative arteriography confirmed an endoleak type II. Although not always able to specify the correct type of linkage, CEUS remains a reliable method for investigating the postoperative complications of AAA.