1 / 29

Endoleak

Endoleak. Hassan Ravari MD Associated Professor of Vascular Surgery Mashhad-Imam Reza Hospital Department of vascular surgery. Endoleak. * Prevalence. * Classification. * Diagnosis. * Definition. * Treatment. * Prevention. Endoleak. * Persistent perfusion of

huslu
Download Presentation

Endoleak

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Endoleak • Hassan Ravari MD • Associated Professor of Vascular Surgery • Mashhad-Imam Reza Hospital • Department of vascular surgery

  2. Endoleak * Prevalence * Classification * Diagnosis * Definition * Treatment * Prevention

  3. Endoleak * Persistent perfusion of the aneurysm sac after EVAR Definition * Persistent blood flow and pressure within the aneurysm sac.

  4. Prevalence Endoleak The most common reason for readmission following EVAR The most common complication following EVAR Range from 8% - 44%

  5. Prevalence * Type - Type I & III 8-12% Endoleak - Type II 8-32% - Type IV 30% - Type V 5% * Mean follow-up - 1 mo 7% - 15 mo 20% - 5 yr 32% * TAAA - 24%

  6. Classification Endoleak ( < 30 days ) Secondary ( Late ) endoleak ( > 30 days ) Delayed endoleak Primary ( Early ) endoleak missed endoleak new endoleak

  7. Classification * Type I Attachment Site Leaks Endoleak - IA Proximal end - IB Distal end - IC Iliac occluder * Type II Branch Leaks ( Lumbar – IMA – Subclavian – Renal - ) - IIA Simple ( 1 branch ) - IIB Complex ( 2 or more )

  8. Classification * Type III Graft defect Endoleak - IIIA Modular disconnection - IIIB Fabric disruption Minor ( <2 mm ) Major ( 2 mm or more) * Type IV Graft wall porosity <30 days after graft placement * Type V Endotension

  9. Diagnosis - CT scan ( IV contrast) Endoleak - Colour Duplex Ultrasonography - MR Angiography - Selective Angiography - Plain X- rays

  10. Diagnosis CT scan ( IV contrast) Endoleak Accepted method Type II endoleak can be missed Biphasic Helical CT imaging Origin & Type of endoleak (?) Radiation Exposure (?) Contrast infusion (?)

  11. Diagnosis Colour Duplex Ultrasonography Endoleak Dynamic Picture Biphasic or monophasic To/Fro wave (benign course) Contrast agent that improve signal Operator dependency (?)

  12. Diagnosis MR Angioraphy Endoleak More sensitive in Type II endoleak In expanding aneurysm sac with no identified endoleak on CT

  13. Diagnosis Selective Angiography Endoleak Completion angiography Suspected to the branch leak Diagnostic & Therapeutic ( simultaneously) Invasive procedure (?)

  14. Diagnosis Plain X- rays Endoleak Graft migration Limb disconnection Wire breakage Kinks

  15. Diagnosis Endoleak Biphasic HelicalCT scan ( IV contrast) Plain X- rays

  16. Treatment Type I Attachment Site Leaks Endoleak Should be treated immediately Distal endoleak (IB) less dangerous

  17. Treatment Type I Attachment Site Leaks Endoleak Endovascular if possible Balloon angioplasty (simple molding) Emobolisation (Coil , Glue or liquid adhesive ) Pulmaz stent A second device

  18. Treatment Type I Attachment Site Leaks Endoleak Laparoscopic peri-aortic ligatures Laparotomy peri-aortic ligatures Best following insertion of a Pulmaz stent Dissection of the aortic neck Nylon tapes Until the pulsatile motion of then aneurysm sac diminished

  19. Treatment Type I Attachment Site Leaks Endoleak Traditional open repair At the same time ( ? ) To clamp supraceliac Intra-aortic occlusion balloon Direct suturing of the endoleak To remove or to cut the graft (hooks or barbs ? ) Implanting a conventional graft

  20. Treatment Type II Branch Leaks Endoleak Controversies : 1- No treatment if detected on completion angiography 2- Early intervention due to risk of rupture 3- Indications for intervention: Enlarging aneurysmal sac ( 5 mm) Persistent endoleak ( 6 mo)

  21. Treatment Type II Branch Leaks Endoleak - Transarterial embolotherapy Access to IMA is through SMA , middle colic & arc of Riolan Access to lumbar a. is through internal iliac and ilio-lumbar a. Coil and glue High failure rate (60%) Complications ( paraplegia, colonic necrosis)

  22. Treatment Type II Branch Leaks Endoleak - Translumbar embolotherapy Treatment of choice More successful & durable Coil and glue No complication reported

  23. Treatment Type II Branch Leaks Endoleak - Laparoscopic branch ligation Alternative Treatment Retroperitoneal approach

  24. Treatment Type II Branch Leaks Endoleak - Injection of thrombogenic sponge after a Sacogram

  25. Treatment Type III Graft defect Endoleak Should be treated immediately Endovascular (covered stent) Conventional open repair

  26. Treatment Type IV Graft wall porosity Endoleak Conservative A diagnostic dilemma

  27. Treatment Type V Endotension Endoleak Should be treated Endovascular (covered stent) Conventional open repair

  28. Prevention Endoleak * Patients selection (guidelines) (exclusion criteria ? ) (patent IMA , large aneurysm , short neck ,wide neck , severe angulation , older age , no thrombus in the sac) * Graft design * Preoperative embolization (IMA & lumbar a.) * Good operative planning

  29. Prevention * Graft oversizing (20 %– 30%) Endoleak * Good graft deployment * Telescope technique 30 mm in straight segments 50 mm in curved segments * Thrombogenic sponge injection in the aneurysm sac

More Related