Endoleak after endovascular graft repair of experimental aortic aneurysms: does coil embolization with angiographic "seal" lower intraaneurysmal pressure?
OBJECTIVE
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 LAP 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 < 0.0001 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 ratio 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.
Marty
B
B
Department of Surgery, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, New York, NY, USA.
Sanchez
L A
LA
Ohki
T
T
Wain
R A
RA
Faries
P L
PL
Cynamon
J
J
Marin
M L
ML
Veith
F J
FJ
D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000792:Angiography; D000818:Animals; D001014:Aortic Aneurysm / Q000601:surgery*; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004195:Disease Models, Animal; D004285:Dogs; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D015607:Stents; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex