Treatment of leaks after endovascular repair of aortic aneurysms.
OBJECTIVE
To evaluate leaks after the endovascular repair of aortic aneurysms and treat them with occlusive therapy.


METHODS
Seventy patients (11 women, 59 men), aged 26-82 years (mean, 69.2 years), underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Indications were traumatic pseudoaneurysms (n = 5) or arteriosclerotic aneurysms (n = 65). Aneurysms were thoracic (n = 5) or infrarenal (n = 65). To exclude the possibility of leaks, spiral computed tomography (CT) was performed at 3-month intervals. Patients with leaks that persisted unchanged longer than 3 months were referred for angiography and occlusive therapy.


RESULTS
At CT, 21 leaks were identified in 17 of 70 patients (24%). Only 11 of those 17 patients (65%) had leaks identified with conventional aortography. Selective angiography, however, depicted all of these. Eighteen of 21 leaks proved amenable to occlusive treatment: surgery (n = 1), further stent implantation (n = 4), or embolization (n = 13). In one leak, spontaneous occlusion occurred after 3 months. Two leaks in either the iliolumbar or the median sacral artery were inaccessible; one remained untreated, and the other was unsuccessfully treated. Mean follow-up of occlusive therapy was 6.8 months (range, 2-14 months).


CONCLUSIONS
Successful occlusion of perigraft leaks is feasible in most cases and can be performed without major complications.
Görich
J
J
Department of Radiology, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany.
Rilinger
N
N
Sokiranski
R
R
Krämer
S C
SC
Ermis
C
C
Schütz
A
A
Brambs
H J
HJ
Söldner
J
J
Kaiser
W
W
Sunder-Plassmann
L
L
Pamler
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D017541:Aneurysm, False / Q000601:surgery; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D001027:Aortography; D001158:Arteries / Q000473:pathology; D001161:Arteriosclerosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002406:Catheterization, Peripheral; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000098:blood supply; D008159:Lumbar Vertebrae / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012447:Sacrum / Q000098:blood supply; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome