1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
2 Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands.
J Endovasc Ther. 2018 Jun;25(3):366-375. doi: 10.1177/1526602818764616. Epub 2018 Mar 26.
To describe the added value of determining changes in position and apposition on computed tomography angiography (CTA) after endovascular aneurysm repair (EVAR) to detect early caudal displacement of the device and to prevent type Ia endoleak.
Four groups of elective EVAR patients were selected from a dataset purposely enriched with type Ia endoleak and migration (>10 mm) cases. The groups included cases of late type Ia endoleak (n=36), migration (n=9), a type II endoleak (n=16), and controls without post-EVAR complications (n=37). Apposition of the endograft fabric with the aortic neck, shortest distance between the fabric and the renal arteries, expansion of the main body (or dilatation of the aorta in the infrarenal sealing zone), and tilt of the endograft toward the aortic axis were determined on the first postoperative and the last available CTA scan without type Ia endoleak or migration. Differences in these endograft dimensions were compared between the first vs last scan and among the 4 groups.
No significant differences in endograft configurations were observed among the groups on the first postoperative CTA scan. On the last CTA scan before a complication arose, the position of the fabric relative to the renal arteries, expansion of the main body, and apposition of the fabric with the aortic neck were significantly different between the type Ia endoleak (median follow-up 15 months) and migration groups (median follow-up 23 months) compared with the control group (median follow-up 19 months). Most endograft dimensions had changed significantly compared with the first postoperative CTA scan for all groups. Apposition had increased in the control group but had decreased significantly in the type Ia endoleak and migration groups.
Progressive changes in dimensions of the endograft within the infrarenal neck could be detected on regular CTA scans before the complication became urgent in many patients.
描述血管内动脉瘤修复术（EVAR）后通过计算机断层血管造影（CTA）确定位置和对位变化的附加价值，以检测器械的尾部早期移位并预防 Ia 型内漏。
从专门包含 Ia 型内漏和迁移（>10mm）病例的数据集中选择四组择期 EVAR 患者。这些组包括晚期 Ia 型内漏（n=36）、迁移（n=9）、II 型内漏（n=16）和无 EVAR 后并发症的对照组（n=37）。在没有 Ia 型内漏或迁移的情况下，在术后第一次和最后一次可获得的 CTA 扫描上确定移植物织物与主动脉颈的对位、织物与肾动脉之间的最短距离、主体扩张（或在肾下密封区扩张主动脉）以及移植物向主动脉轴倾斜。比较第一次与最后一次扫描之间以及四组之间这些移植物尺寸的差异。
在术后第一次 CTA 扫描中，各组之间的移植物形态没有明显差异。在出现并发症之前的最后一次 CTA 扫描上，相对于肾动脉的织物位置、主体扩张和织物与主动脉颈的对位在 Ia 型内漏（中位随访 15 个月）和迁移组（中位随访 23 个月）与对照组（中位随访 19 个月）之间存在显著差异。与第一次术后 CTA 扫描相比，所有组的大多数移植物尺寸都发生了显著变化。对照组的对位增加，但 Ia 型内漏和迁移组的对位显著减少。
在许多患者中，在并发症变得紧急之前，可以在常规 CTA 扫描上检测到肾下颈部移植物尺寸的进行性变化。
