Endoleak biphasic

Type II endoleaks can be associated with aneurysmal expansion and rupture however, this risk is much less than with the type I and III endoleaks (0.5 versus 3.4 %) [9,10]. Aleak in the setting of a shrinking aneurysm can generally be followed, without immediate intervention. It is well established that up to 40 % of type II endoleaks will seal spontaneously. Some have advocated intervening in all endoleaks persisting beyond 3-6 months, while other groups recommended observing leaks in the absence of aneurysm expansion. We favor the last approach. In our experience with biphasic helical CT follow-up of more than 300 patients treated by EVAR from 1994 to 1998, only three patients needed intervention for type II endoleak. 

The value of biphasic or triphasic CT scanning has been established for follow up of EVAR [19, 20]. Some authors favor obtaining an unenhanced helical CT series. Rozenblit at al. have demonstrated that the unenhanced series were helpful to diagnose an indeterminate endoleak in one patient [20]. Important mimickers of endoleak include calcification, contrast within the folds of unsupported portions of the graft and residual endosac contrast from the initial procedure when early CT follow-up is obtained at 1-3 days. This pseudo-endoleak was seen in up to 57% of patients [21]. 

In a series of 55 patient with CDUS compared to biphasic CTA, CT was superior in detection of small leak. Discrepancies between helical CT and CDUS were observed in eight patients (14.5%). In five cases, a small perigraft leak that was clearly demonstrated by helical CT was not found on CDUS. All these leaks were small and disappeared during the follow-up. For the diagnosis of endoleak, the sensitivity, the specificity, the positive and negative pre-... 

McWilliams RG, Martin J, White D, et al (2002) Detection of endoleak with enhanced ultrasound imaging comparison with biphasic computed tomography.) Endovasc Ther 9 170-179... 

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See also in sourсe #XX -- [ ]

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