title: Endoleak after endovascular graft repair of experimental aortic aneurysms: does coil embolization with angiographic "seal" lower intraaneurysmal pressure?
abstract: 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.
authors.affiliation: Department of Surgery, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: B
authors.initials: B
authors.lastname: Marty
authors.forename: L A
authors.initials: LA
authors.lastname: Sanchez
authors.forename: T
authors.initials: T
authors.lastname: Ohki
authors.forename: R A
authors.initials: RA
authors.lastname: Wain
authors.forename: P L
authors.initials: PL
authors.lastname: Faries
authors.forename: J
authors.initials: J
authors.lastname: Cynamon
authors.forename: M L
authors.initials: ML
authors.lastname: Marin
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
mesh_terms: 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