Type II endoleak after endoaortic graft implantation: diagnosis with helical CT arteriography.
OBJECTIVE
To retrospectively assess endoleak shapes and locations within aneurysms to differentiate type II from type I and type III endoleaks.


METHODS
The institutional review board granted an exemption for this HIPAA-compliant study; patient informed consent was not required. A retrospective review of arterial phase helical computed tomographic (CT) studies and medical records was performed for 39 patients (29 men, 10 women; age range, 60-89 years; mean, 78.5 years) who had an endoleak after endoaortic graft implantation for treatment of abdominal aortic aneurysm and who subsequently underwent angiography (n = 25), surgery (n = 8), or long-term follow-up (n = 6) to classify their endoleak into a specific type. At CT, endoleak shape (tubular or nontubular) and location (central or peripheral) were recorded. An endoleak was classified as type II if it contained a peripheral tubular component (PTC) near the aortic wall, with or without an identifiable feeding vessel. Endoleaks without these features were classified as type I or III. The Fisher exact test was used to assess associations between CT findings and endoleak type.


RESULTS
There were 22 type II and 17 type I or III endoleaks. CT enabled correct identification of 22 (100%) of 22 type II endoleaks, all of which contained a PTC. Of 17 type I or III endoleaks, only two (12%) contained a PTC and were misclassified as type II endoleaks; the remaining 15 (88%) were correctly classified. Overall, CT enabled correct identification of endoleaks as type II or type I or III in 37 (95%) of 39 patients. PTCs were significantly more common (P < .001) in type II than in type I or III endoleaks, with a sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 100%, 88.2%, 94.9%, 100%, and 91.7%, respectively.


CONCLUSIONS
A PTC is a statistically significant predictor of type II endoleak in most patients.
Chernyak
Victoria
V
Departments of Radiology and Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA. vichka17@hotmail.com
Rozenblit
Alla M
AM
Patlas
Michael
M
Cynamon
Jacob
J
Ricci
Zina J
ZJ
Laks
Mitchell P
MP
Veith
Frank J
FJ
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000000981:diagnostic imaging*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed