C-Arm CT - An adjunct to DSA for endoleak classification in patients with endovascular repair of abdominal aortic aneurysms

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 etal. 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.© Georg Thieme Verlag KG Stuttgart.