Search
Print this page
December 23, 2005
Back to Program
Timothy P. Milner, MD, Christopher D. Scibelli, MD, Hosam F. El Sayed, MD, George H. Meier, III, MD, Gregory A. Barber, MD, Michael M. Marcinczyk, MD, F N. Parent, MD, Martin A. Fogle, MD, Robert G. Gayle, MD, Gordon K. Stokes, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES:
The presence of endoleak after EVAR is a common occurrence, necessitating lifelong surveillance of the aneurysm sac to avoid long term complications. While the presence of flow outside the endograft but within the aneurysm sac is an accepted definition of endoleak, entities such as endotension may not have apparent flow. These patients may have low flow endoleak or other abnormalities less well defined. We describe here a series of patients with abnormal grayscale aneurysm sac morphology, whose clinical behavior is poor, resulting in a high rate of post EVAR intervention.
METHODS:
A retrospective review of all patients who underwent routine surveillance after EVAR from August 2001 to May 2004 was performed. Patients whose scans exhibited a grayscale abnormality with heterogeneous “spongy” morphology were identified. Demographics, pre-treatment aneurysm characteristics, clinical course and post-operative imaging were analyzed.
RESULTS:
Over the 33 month interval, a total of 14 patients were identified with this characteristic appearance by grayscale ultrasound imaging. In these patients endoleak was confirmed by color flow ultrasound in all cases except one. Endoleak detection was often difficult, requiring multiple examinations in several to confirm its presence. In all cases, aneurysm sac expansion occurred in follow up. Eight of these patients ultimately required intervention for their endoleaks and the associated aneurysm sac expansion.
CONCLUSIONS:
CT and ultrasound can both effectively detect the presence of complications following EVAR. We describe here a new ultrasound aneurysm sac characteristic predicting adverse outcome after EVAR, representing a heterogeneous, low flow endoleak. This gray scale abnormality resulted in a high rate of subsequent intervention and was universally associated with aneurysm sac expansion. Gray scale ultrasound aneurysm sac morphology is an important adjunct to color flow duplex ultrasound and contrast enhanced CT in the detection of endoleak. The appearance of a “spongy” heterogeneous echogenicity within the aneurysm sac after EVAR, particularly in conjunction with an expanding aneurysm sac, should precipitate an aggressive search for undiagnosed endoleak.
Back to Annual Meeting
Back to Program
Spongy Aneurysm Sac Morphology after EVAR: Clinical Implications of a New Ultrasound Finding
Back to Annual MeetingBack to Program
Timothy P. Milner, MD, Christopher D. Scibelli, MD, Hosam F. El Sayed, MD, George H. Meier, III, MD, Gregory A. Barber, MD, Michael M. Marcinczyk, MD, F N. Parent, MD, Martin A. Fogle, MD, Robert G. Gayle, MD, Gordon K. Stokes, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES:
The presence of endoleak after EVAR is a common occurrence, necessitating lifelong surveillance of the aneurysm sac to avoid long term complications. While the presence of flow outside the endograft but within the aneurysm sac is an accepted definition of endoleak, entities such as endotension may not have apparent flow. These patients may have low flow endoleak or other abnormalities less well defined. We describe here a series of patients with abnormal grayscale aneurysm sac morphology, whose clinical behavior is poor, resulting in a high rate of post EVAR intervention.
METHODS:
A retrospective review of all patients who underwent routine surveillance after EVAR from August 2001 to May 2004 was performed. Patients whose scans exhibited a grayscale abnormality with heterogeneous “spongy” morphology were identified. Demographics, pre-treatment aneurysm characteristics, clinical course and post-operative imaging were analyzed.
RESULTS:
Over the 33 month interval, a total of 14 patients were identified with this characteristic appearance by grayscale ultrasound imaging. In these patients endoleak was confirmed by color flow ultrasound in all cases except one. Endoleak detection was often difficult, requiring multiple examinations in several to confirm its presence. In all cases, aneurysm sac expansion occurred in follow up. Eight of these patients ultimately required intervention for their endoleaks and the associated aneurysm sac expansion.
CONCLUSIONS:
CT and ultrasound can both effectively detect the presence of complications following EVAR. We describe here a new ultrasound aneurysm sac characteristic predicting adverse outcome after EVAR, representing a heterogeneous, low flow endoleak. This gray scale abnormality resulted in a high rate of subsequent intervention and was universally associated with aneurysm sac expansion. Gray scale ultrasound aneurysm sac morphology is an important adjunct to color flow duplex ultrasound and contrast enhanced CT in the detection of endoleak. The appearance of a “spongy” heterogeneous echogenicity within the aneurysm sac after EVAR, particularly in conjunction with an expanding aneurysm sac, should precipitate an aggressive search for undiagnosed endoleak.
Back to Annual Meeting
Back to Program
© 2009Copyright Society for Clinical Vascular Surgery
Read the Privacy Policy.
Read the Privacy Policy.