1、Endoleaks after endovascular aortic Stent-Grafting:CT diagnosisLuo SongDepartment of Medical Imaging,Jinling HospitalOutline Concept and history Cause Imaging diagnose Classification CT characters SummaryConcept and history In 1991,the first successful endovascular abdominal aortic repair(EVAR)In 19
2、94,the first thoracic endovascular aortic repair(TEVAR)In 1996,White first suggested that this phenomenon of incomplete between the aortic wall and a stent-graft resulting in“paragraft flow”be termed endoleakConcept and history Whites group then suggested a classification nomenclature based on time
3、and site of occurrence In 1998,White et al revised their endoleak classification scheme again into 4 distinct types and an additional type(endotension)White et al.J ENDOVASC SURG,1998Concept and history Endotension:there is demonstrable pressure within a sac but no endoleak identified In 2002 a cons
4、ensus conference was held on endoleaks and endotension after EVAR,and a classification scheme was formalizedVeith FJ et al.J Vasc Surg,2002景在平等，中国实用外科杂志，2002Cause Proximal Distal Stent-graft Branch vesselsClinical aortic-related mortality reoperation reintervention Incidence rate:between 12%and 20%I
5、maging diagnose CT DSA MRI UltrasoundDSAGleason et al.Thoracic and Cardiovascular Surgery,2009 MRI blood-pool time-resolved cine Pitton et al.AJR,2005 Ultrasound Operator expertise Body habitus Bowel gas The air within the lung TEE Intravascular ultrasoundClassification Time Within 30 days:primary o
6、r early Occurring later:secondary,delayed,or late Site Graft-related or perigraft Noggraft-related or retrogradeWhite et al.J ENDOVASC SURG,1998ClassificationClassificationSze et al.Circ Cardiovasc Intervent,2009ClassificationType Flow from either the proximal or distal The most common typeType Retr
7、ograde aortic branch vessel blood flowThe left subclavian arteryType Structural failure with the stent graft Holes in the stentgraft fabric,Stent-graft fractures Junctional separationsAngularType From the pores seep through and into the excluded segment of aorta Earlier generation stent-graftsArtery phaseDelay phaseSummary Classification is important Endoleak classification:thoracic aortic dissection endovascular aortic repair Lehmkuhl,et al.Radiology,2013,9 Research progressSommer et al.Radiology,2012Stolzmann et al.Radiology 2008
