Purpose: To evaluate type II endoleak nidus volume (ENV) in the arterial phase (ENV) and delayed phase (ENV) of the first postoperative CT angiography (CTA) as a predictor of persistent endoleak and aneurysm sac enlargement at follow-up CTA in patients with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm.
Materials And Methods: Ninety-three patients (mean age ± standard deviation, 72 years ± 8; range, 56-88 years) with EVAR and type II endoleak were included in a single-institution retrospective study conducted between March 1, 2005, and December 31, 2018. ENV, ENV, change of volume (ENV), and percentage of ENV and ENV in aneurysm sac volume (ASV) (ENV/ASV%, ENV/ASV%, respectively) were measured on first postoperative CTA images. The mean follow-up was 31.6 months ± 26.6 (range, 6-163.8 months). Patients were divided into two groups (group A, spontaneous resolution of endoleak without intervention [ = 29] and group B, persistent endoleak at follow-up CTA [ = 64]) and compared by using the Mann-Whitney , Wilcoxon signed rank, and Pearson χ tests. Receiver operating characteristic (ROC) analysis was used to compare accuracies of parameters at first postoperative CTA.
Results: The accuracy of ENV (area under the ROC curve [AUC], 0.78) was superior to the accuracy of ENV/ASV% (AUC, 0.76), ENV (AUC, 0.74), ENV (AUC, 0.71), and ENV/ASV% (AUC, 0.69) in indicating persistent endoleak. In group B, 46 patients (72%) showed ASV enlargement and 44 patients (69%) underwent endoleak embolization. ENV (1.7 cm ± 2.9 vs 3.4 cm ± 4.2; = .001), ENV (2.9 cm ± 3.8 vs 8.0 cm ± 9.6; < .001), ENV (1.1 cm ± 1.8 vs 4.5 cm ± 7.8; < .001), ENV/ASV% (0.9% ± 1.5 vs 1.7% ± 2.2; = .003), and ENV/ASV% (1.6% ± 2.2 vs 3.7% ± 3.6; < .001) were smaller in group A than in group B.
Conclusion: ENV of the first postoperative CTA is an accurate predictor of persistent endoleak compared with ENV, and persistent endoleak is associated with aneurysm sac enlargement, in which earlier intervention is recommended.© RSNA, 2021.
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| http://dx.doi.org/10.1148/ryct.2021200527 | DOI Listing |
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