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Add to Cart. View Full Details and Buy. Complementary Documents and Links:. Some of this controversy surrounds the complications of EVAR and what to do about them. Resolving these contentious issues is becoming more important because as the endografts remain in place for longer periods of time, the incidence of problems is increasing.
Endoleaks and Endotension: Current Consensus on Their Nature and Significance
Clearly, the most common problems developing after EVAR are the occurrence of endoleaks blood flow outside the graft and endotension increased pressure within the aneurysm sac. Although all will agree that these entities have a complex etiology, there is much disagreement about how best to diagnose and manage them when they occur.
We conceived of the William J. Certainly the nature and significance of endoleaks and endotension are ideal topics to address through such a consensus process. These problems, and what to do for the patients who have them, present an increasing challenge to those involved in EVAR. Moreover, we need to do a better job of preventing them.
In late , 27 experienced experts with a profound interest in endoleaks and endotension came together to focus on these topics. This book represents a distillate of their consensus process and its conclusions. It also includes chapters by these experts. Each chapter presents relevant data and individual perspectives and opinions. Although answers to all questions regarding endoleaks and endotension may not be known, this volume summarizes the current state of knowledge and opinion regarding these problems.
In this setting, duplex scanning for EVAR follow up is reliable, cost-effective, and well accepted by patients. As such, compliance with scheduled follow up may be improved.
The occasional incomplete examination due to technical limitations, overlying bowel gas, or patient habitus can be recognized by the technologist and reported. If a good vascular laboratory is available, a practical strategy is to get both a contrast-enhanced CT and a duplex scan when the first post-EVAR imaging is done. Duplex scanning can then be used for surveillance.
Follow up imaging with CT scan can be used selectively, when additional information for endoleak characterization is needed. Type I and III endoleaks need treatment. The duplex ultrasound findings associated with endoleaks are summarized in Table 2. Table 2: Sonographic features of endoleaks B-mode gray-scale imaging Contents of aneurysm sac may be appear heterogeneous Color Doppler imaging Flow detected within the aneurysm sac Flow in lumbar or inferior mesenteric arteries may be seen Power Doppler imaging Flow detected within the aneurysm sac Pulsed Doppler spectral Doppler Low velocity flow within the aneurysm sac, typically with to-fro pattern Contrast-enhanced imaging Enhancement of blood in aneurysm sac after contrast injection Seen with B-mode or harmonic imaging It is best to have duplex scanning performed by a qualified individual using standardized techniques, e.
SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg ; Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms. Conservative management of type 2 endoleaks is not associated with increased risk of aneurysm rupture. Eur J Vasc Endovasc Surg ; Outcome and clinical significance of delayed endoleaks after endovascular aneurysm repair. Pandey N, Litt HI.
Endoleaks and Endotension: Current Consensus on Their Nature and Significance - Google книги
Surveillance imaging following endovascular aneurysm repair. Semin Intervent Radiol ; Duplex ultrasound and contrast-enhanced ultrasound versus computed tomography for the detection of endoleak after EVAR: systematic review and bivariate meta-analysis. A systematic review of ultrasound or magnetic resonance imaging compared with computed tomography for endoleak detection and aneurysm diameter measurement after endovascular aneurysm repair.
J Endovasc Ther ; Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device. Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair.
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Br J Surg ; Evaluating outcomes of endoleak discrepancies between computed tomography scan and ultrasound imaging after endovascular abdominal aneurysm repair. Ann Vasc Surg ; Share via:.
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Retrograde arterial branch flow from a inferior mesenteric artery or b lumbar arteries. Incomplete seal between components, component separation, fabric erosion, or tear. Leak due to fabric porosity generally only present at the time of operation.
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