Endoleak delayed acquisition

It has been demonstrated that delayed acquisition uncovered up to 11% of endoleaks that were missed by arterial phase alone [19,20]. An optimal CT protocol for the monitoring of the aorta after endolu-minal therapy should include a delayed acquisition (Fig. 14.7). 

It seems certain that EVAR will continue to be a primary treatment for many years. Endoleak is an ongoing problem associated with EVAR. Imaging plays a critical role in detecting endoleak. CTA is the first line diagnostic modality. Optimal CTA protocol needs to include a delayed acquisition. There are many endovascular options available for treatment of persistent endoleaks. The optimal treatment depends on the type of the endoleak. 

Endotension (or type V endoleak) corresponds to continued aneurysm expansion in the absence of a confirmed endoleak [12, 13], The expansion of the aneurysm in a type V endoleak may be due to an undiagnosed endoleak, presumably with very slow flow and suboptimal imaging (e.g. no delayed helical CT acquisition). Endotension has been reported up to 18% in [14] a study evaluating the significance of endotension in 658 patients. The authors demonstrated that endotension is rare and concluded that it may represent missed endoleak rather than true aneurysm expansion in the absence of perigraft flow [15]. 

Rosenblit AM, Patlas M, Rosenbaum AT, et al (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysms value of unenhanced and delayed CT acquisitions. Radiology 227 426-433... 

Rozenblit AM, Patlas M, Rosenbaum AT et al. (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysm value of unenhanced and delayed helical CT acquisitions. Radiology 227 426-433 Smith RC, Rosenfield AT, Choe KA etal. (1995) Acute flank pain comparison of noncontrast-enhanced CT and intravenous urography. Radiology 194 789-794 Szolar DH, Kammerhuber F, Altziebler S et al. (1997) Multi-phasic helical CT of the kidney increased conspicuity for detection and characterization of small (< 3-cm) renal masses. Radiology 202 211-217... 

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