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Rofo 2014; 186(3): 247-252
DOI: 10.1055/s-0033-1350500
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

C-Arm CT – An Adjunct to DSA for Endoleak Classification in Patients with Endovascular Repair of Abdominal Aortic Aneurysms

C-Arm-CT – eine wertvolle Ergänzung zur DSA fur Endoleak-Klassifikation bei Patienten nach endovaskulärer Therapie eines Bauchaortenaneurysmas
F. K. Wacker
1   Institute of Diagnostic and Interventional Radiology, University School of Medicine Hannover
,
S. Valdeig
2   Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore
,
H. J. Raatschen
1   Institute of Diagnostic and Interventional Radiology, University School of Medicine Hannover
,
B. C. Meyer
1   Institute of Diagnostic and Interventional Radiology, University School of Medicine Hannover
› Author Affiliations
Further Information

Publication History

26 February 2013

24 July 2013

Publication Date:
02 September 2013 (online)

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Abstract

Purpose: To assess the benefit of C-arm CT for classification and procedural guidance during interventional therapy of endoleaks (EL) after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA).

Materials and Methods: 12 patients with EL diagnosed with CT but undetermined EL classification (ELC) underwent DSA and transarterial contrast-enhanced C-arm CT. ELC (based on DSA, C-arm CT and CT) assessed during the angiographic procedure served as the standard of reference (SOR). Subsequently, ELC was assessed by a blinded second reader based on DSA or C-arm CT and compared to the SOR. In the case of an interventional procedure (n = 6), the added value of C-arm CT for procedure guidance was assessed retrospectively (1: essential, 2: helpful, 3: additional information without impact, 4: no additional information).

Results: The blinded reader classified 9/12 EL using DSA alone and 11/12 EL using C-arm CT alone. In one patient, the temporal resolution provided by DSA was essential to establish the diagnosis. In 6 patients, a type 2 EL without need for therapy was diagnosed. The remaining 6 patients showed EL that were treated immediately (type 1 EL, n = 4: 3 stent graft extensions and one angioplasty; type 2 EL, n = 1: translumbar embolization; type 3 EL, n = 1: sealing of a fabric tear). The information provided by C-arm CT was assessed to be essential in three patients and helpful in two.

Conclusion: C-arm CT is an ideal adjunct to DSA. In our pilot study, it helped to localize and classify endoleaks more reliably than DSA alone.

Citation Format:

• Wacker FK, Valdeig S, Raatschen HJ et al. C-Arm CT – An Adjunct to DSA for Endoleak Classification in Patients with Endovascular Repair of Abdominal Aortic Aneurysms. Fortschr Röntgenstr 2014; 186: 247 – 252

Zusammenfassung

Ziel: Bestimmung der Wertigkeit der C-Arm-CT zur Klassifikation und Steuerung der interventionellen Therapie von Endoleckagen (EL) nach endovaskulärer Stentgrafttherapie (EVAR) abdomineller Aortenaneurysmen (AAA).

Material und Methode: 12 Patienten mit in der CT diagnostiziertem EL und unklarer EL Klassifizierung (ELC) wurden mittels DSA und transarteriell kontrastmittelverstärkter C-Arm-CT untersucht. Die ELC (basierend auf DSA, C-Arm-CT und CT) im Rahmen der angiografischen Untersuchung diente als Referenzstandard (SOR); Die anschließend durch einen verblindeten zweiten Leser entweder anhand der DSA oder der C-Arm-CT-Bilder erhobene ELC wurde mit dem SOR verglichen. Im Fall einer interventionellen Therapie (n = 6) wurde der Mehrwert der C-Arm-CT zur Planung der Intervention retrospektiv erhoben (1: essenziell, 2: hilfreich, 3: Zusatzinformation ohne Relevanz, 4: keine Zusatzinformation).

Ergebnisse: Durch den verblindeten Radiologen wurden basierend auf der DSA 9/12 EL und basierend auf der C-Arm-CT 11/12 EL korrekt klassifiziert. Bei einem Patienten war die zeitliche Auflösung der DSA für die korrekte ELC zielführend. Bei 6 Patienten wurde ein Typ-2-EL ohne Behandlungsbedarf diagnostiziert. Bei den verbleibenden 6 Patienten wurde das EL sofort behandelt (Typ-1-EL, n = 4: 3 Stentgraftverlängerungen und eine Angioplastie; Typ-2-EL, n = 1: perkutane Embolisation; Typ-3-EL, n = 1: Überdeckung des Materialfehlers). Der Mehrwert der C-Arm-CT wurde bei 3 Patienten als essenziell und bei 2 als hilfreich bewertet.

Schlussfolgerungen: Die C-Arm-CT ist eine gute Ergänzung zur DSA. Lokalisierung und Klassifikation von Endoleaks gelang in unserer Pilotstudie zuverlässiger als mit alleiniger DSA.

Key words

aorta - angiography - interventional procedures - aneurysm
 

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