TY - JOUR
T1 - Endoleak after endovascular graft repair of experimental aortic aneurysms
T2 - Does coil embolization with angiographic 'seal' lower intraaneurysmal pressure?
AU - Marty, B.
AU - Sanchez, L. A.
AU - Ohki, T.
AU - Wain, R. A.
AU - Faries, P. L.
AU - Cynamon, J.
AU - Marin, M. L.
AU - Veith, F. J.
AU - Wisselink, W.
AU - Ascher, E.
AU - Silane, M. F.
PY - 1998
Y1 - 1998
N2 - Purpose: To investigate the relation between endoleaks and intraaneurysmal pressure (IAP) and the effect of coil embolization in the management of endoleaks. Methods: The infrarenal aorta of a dog (n = 15) was replaced by a polytetrafluoroethylene aneurysm containing a pressure transducer. Group I (n = 4) had untreated aneurysms. Group II (n = 4) had endovascularly excluded aneurysms without an endoleak. Group III (n = 7) had aneurysms excluded by means of grafts with a defect that represented the source of an endoleak. After 4 weeks of follow-up study, the endoleaks in group III dogs were subjected to coil embolization. Systolic IAP was measured daily and expressed as a ratio of systolic blood pressure obtained from a forelimb cuff. Arteriography, duplex ultrasonography, and spiral contrast computed tomography were performed to evaluate endoleaks. Results: In group I, the IAP remained close to systolic blood pressure (ratio of 0.96 ± 0.06), whereas in group II the IAP ratio showed a decline to 0.34 ± 0.16 (p = 0.0009 group I versus II). After an initial decrease, the IAP ratio in group III stabilized at 0.75 ± 0.18 (p = 0.003, group II versus III). Aneurysms with an endoleak remained pulsatile with a pulse pressure of 30 ± 16 mm Hg, which was less than that of untreated aneurysms (62 ± 15 mm Hg; p < 0.001 group I versus III). Arteriography and computed tomography revealed 'sealing' of endoleaks after coil embolization, but IAP ratio did not decrease (0.76 ± 0.14) after coil embolization. Conclusions: Incomplete endovascular aneurysm exclusion caused by an endoleak fails to reduce IAP ration and may subject the aneurysm to a continued risk for rupture. Although coil embolization resulted in angiographic and computed tomographic sealing, it failed to reduce IAP ratio.
AB - Purpose: To investigate the relation between endoleaks and intraaneurysmal pressure (IAP) and the effect of coil embolization in the management of endoleaks. Methods: The infrarenal aorta of a dog (n = 15) was replaced by a polytetrafluoroethylene aneurysm containing a pressure transducer. Group I (n = 4) had untreated aneurysms. Group II (n = 4) had endovascularly excluded aneurysms without an endoleak. Group III (n = 7) had aneurysms excluded by means of grafts with a defect that represented the source of an endoleak. After 4 weeks of follow-up study, the endoleaks in group III dogs were subjected to coil embolization. Systolic IAP was measured daily and expressed as a ratio of systolic blood pressure obtained from a forelimb cuff. Arteriography, duplex ultrasonography, and spiral contrast computed tomography were performed to evaluate endoleaks. Results: In group I, the IAP remained close to systolic blood pressure (ratio of 0.96 ± 0.06), whereas in group II the IAP ratio showed a decline to 0.34 ± 0.16 (p = 0.0009 group I versus II). After an initial decrease, the IAP ratio in group III stabilized at 0.75 ± 0.18 (p = 0.003, group II versus III). Aneurysms with an endoleak remained pulsatile with a pulse pressure of 30 ± 16 mm Hg, which was less than that of untreated aneurysms (62 ± 15 mm Hg; p < 0.001 group I versus III). Arteriography and computed tomography revealed 'sealing' of endoleaks after coil embolization, but IAP ratio did not decrease (0.76 ± 0.14) after coil embolization. Conclusions: Incomplete endovascular aneurysm exclusion caused by an endoleak fails to reduce IAP ration and may subject the aneurysm to a continued risk for rupture. Although coil embolization resulted in angiographic and computed tomographic sealing, it failed to reduce IAP ratio.
UR - http://www.scopus.com/inward/record.url?scp=19244367643&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S0741-5214(98)70320-9
DO - https://doi.org/10.1016/S0741-5214(98)70320-9
M3 - Article
C2 - 9546230
SN - 0741-5214
VL - 27
SP - 454
EP - 462
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 3
ER -