title: Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography.
abstract: OBJECTIVE
  Endovascular treatment of the thoracic aorta has developed as an efficacious alternative to open surgical repair. However, despite the high primary success rate, perigraft leakage constitutes the major concern in long-term follow-up. Endoleaks are widely reported both in abdominal and thoracic endovascular series and are usually identified by intraoperative angiography. Transesophageal echocardiography is a sensitive imaging technique in the evaluation of aortic diseases, widely used to monitor cardiac surgery. The aim of this study was to evaluate the efficacy of transesophageal echocardiography in leakage detection during endovascular stent procedures of the thoracic aorta.
  
  
  METHODS
  Intraoperative transesophageal echocardiography was used in conjunction with angiography in 25 patients subjected to endovascular stent treatment of the descending thoracic aorta. Spiral computed tomographic scanning was performed before discharge and 3, 6, and 12 months after treatment.
  
  
  RESULTS
  Information from transesophageal echocardiography was relevant in the selection of the landing zone in 62% of cases. In 8 patients, transesophageal echocardiography with color Doppler sonography showed a perigraft leak, 6 of which were not visible on angiography, suggesting the need for further balloon expansion or graft extension. Postoperative computed tomographic scanning in the 25 patients showed 1 endoleak, which sealed spontaneously. At 3 months, computed tomographic examination confirmed the absence of perigraft leakage in all patients.
  
  
  CONCLUSIONS
  During implantation of a stent-graft in the descending thoracic aorta, transesophageal echocardiography provides information in addition to that provided by angiography, improving immediate and late procedural results.
authors.affiliation: Departments of Radiology, Cardiovascular Surgery, and Cardiology, University of Bologna, Bologna, Italy. ross@med.unibo.it
authors.forename: R
authors.initials: R
authors.lastname: Fattori
authors.forename: I
authors.initials: I
authors.lastname: Caldarera
authors.forename: C
authors.initials: C
authors.lastname: Rapezzi
authors.forename: G
authors.initials: G
authors.lastname: Rocchi
authors.forename: G
authors.initials: G
authors.lastname: Napoli
authors.forename: M
authors.initials: M
authors.lastname: Parlapiano
authors.forename: M
authors.initials: M
authors.lastname: Favali
authors.forename: A
authors.initials: A
authors.lastname: Pierangeli
authors.forename: G
authors.initials: G
authors.lastname: Gavelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001013:Aorta, Thoracic / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D015607:Stents