Evolution of type II endoleaks based on different ultrasonographically identified patterns
Spyridon Monastiriotis, MD, ignatius Lau, MD, Shang Loh, MD, John Ferretti, MD, Apostolos Tassiopoulos, MD, Nicos Labropoulos.
SUNY at Stony Brook, stony brook, NY, USA.
OBJECTIVES: To delineate the specific types of waveforms that exist in Type 2 Endoleaks (T2EL) and their effect on the aneurysmal sac size.
METHODS: Patients who underwent EVAR and diagnosed with a T2EL were included in the study. The flow velocity characteristics of the T2ELs were evaluated in detail with duplex ultrasound. There were 4 different flow patterns identified. These are high resistance low flow (HRLF), low resistance low flow (LRLF), low resistance high flow (LRHF) and to-fro flow (TFF). The type and number of vessels involved, the time of detection, evolution and need for treatment were recorded. The aneurysm sac diameter was monitored with duplex ultrasound. A baseline computed tomography scan was performed within one month of the procedure and repeated only when the patient developed symptoms or there were changes in the ultrasound exam.
RESULTS: : 56 out of 382 patients that underwent EVAR in our institution were diagnosed with a T2EL (14.65%). There were 52 Male and 4 female with a mean age of 74 years (61-86). The T2EL was diagnosed within the first month for the majority of the patients (32/56), 9 patients were diagnosed at 3 months, 5 patients at 6 months, 3 patients at 9 months and 7 patient were diagnosed at 1 year or later. 43 patients had a T2EL involving 1 vessel, 2 vessels were involved in 11 patients and 3 vessels were involved in 2 patients. HRLF endoleak was detected in 14 patients, of those 13 were occluded and 1 converted to high flow. LRLF endoleak was detected in 7 patients, of those 5 were occluded, 1 remained stable and one converted to high flow with sac enlargement requiring treatment. LRHF was found in 13 patients, of those 8 were occluded, 3 remained stable and 2 had sac enlargement requiring treatment, 1 patient presented with rupture. Finally to-fro flow was identified in the majority of the patients (22), of those 14 occluded, 3 remained stable and 5 had sac enlargement requiring treatment, 2 patients presented with rupture. No deaths due to T2EL were encountered. CONCLUSIONS: Most of the T2EL result in spontaneous occlusion and are not associated with sac enlargement. A high flow or TFF T2EL has higher chances of resulting in sac enlargement and rupture.
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