Dynamic Volumetric Computed Tomography Angiography Is a Preferred Method for Unclassified Endoleaks by Conventional Computed Tomography Angiography After Endovascular Aortic Repair

Abstract

Background: The aim of this study was to assess the feasibility and safety of dynamic volumetric computed tomography angiography (DV-CTA) for endoleaks detected but not classified by conventional CTA in patients after endovascular aortic repair. Methods and Results: From January 2016 to October 2017, 24 patients with endoleaks with aneurysm sac enlargement detected but not classified by conventional CTA were randomly assigned to the conventional CTA group and the DV-CTA group for further evaluation. The amount of contrast agent, radiation dosage, and changes in creatinine during the operation were compared between the 2 groups. Reintervention was performed according to the endoleak classification followed by the 6- and 12-month follow-up. The accuracy of classifying endoleaks by DV-CTA was comparable to that by digital subtraction angiography. Additionally, the total amount of contrast agent and the radiation dosage in the DV-CTA group during the operation were diminished by 14.0% (P=0.007) and 12.1% (P=0.004), respectively, compared with those in the conventional CTA group. No contrast-induced nephropathy was observed. All endoleaks were treated instantly after identification. No endoleaks were found in any of the patients during follow-up. Conclusions: DV-CTA could replace digital subtraction angiography as an alternative method for the classification of endoleaks that cannot be differentiated by conventional CTA. Additionally, the amount of contrast agent and the total radiation dosage were substantially reduced, which improved safety among operators and patients.