"Pseudoendoleak"--residual intrasaccular contrast after endovascular stent-graft repair.
OBJECTIVE
To present a unique demonstration of postoperative perigraft contrast masquerading as an endoleak following endovascular abdominal aortic aneurysm (AAA) repair.


METHODS
A 66-year-old man underwent endovascular stent-graft repair of a 4.6-cm infrarenal AAA. The procedure was uncomplicated, and intraoperative completion angiography demonstrated good proximal and distal fixation of the stent-graft without an endoleak. A spiral computed tomographic (CT) angiogram obtained on postoperative day 2 revealed a large amount of extrastent contrast along the posterior aspect of the aneurysm sac. This defect had the appearance of an endoleak, but it was also present on the non-contrast images. A color-flow duplex examination performed on the same day showed a widely patent stent-graft with no evidence of extrastent flow.


CONCLUSIONS
Contrast trapped in the aneurysm sac during endovascular aneurysm repair may be misinterpreted as an endoleak on postprocedural CT scans. "Pseudoendoleaks" can be distinguished from true endoleaks by examination of prebolus, noncontrast CT images, as well as by duplex ultrasound scanning.
Lee
W Anthony
WA
Division of Vascular Surgery, Stanford University, California, USA. leewa@mail.surgery.ufl.edu
Rubin
Geoffrey D
GD
Johnson
Bonnie L
BL
Arko
Frank
F
Fogarty
Thomas J
TJ
Zarins
Christopher K
CK
D000368:Aged; D000792:Angiography / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D003937:Diagnosis, Differential; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D018615:Ultrasonography, Doppler, Color