Assessing the effectiveness of endografts: clinical and experimental perspectives.
The increasing use of endografts to treat abdominal aortic aneurysms has prompted the need for improved postoperative imaging and surveillance. Although patients benefit from decreased morbidity with endovascular repair compared with open abdominal aortic aneurysm repair, the long-term outcome of stent repair has yet to be fully determined. The persistence of endoleaks highlights the need for close follow-up, particularly because this may lead to aneurysm rupture, even after endograft repair. The current mainstay of assessing the healing of endografts is obtaining serial helical computed tomography angiography (CTA) to identify endoleaks, graft migration, thrombosis, and structural failure. CTA is not completely effective at identifying endoleaks and predicting aneurysm rupture, however. Other modalities have been studied to improve on current imaging methods, including three-dimensional CTA with volumetric analysis, contrast-enhanced duplex ultrasound imaging, cine magnetic resonance angiography, and explant analysis. In vitro and large-animal models of abdominal aortic aneurysm have also been developed to study the pathophysiology and treatment response of aneurysm exclusion. Thus, clinical and experimental models of endograft healing are attempting to define the optimal method of postoperative surveillance of endovascular repair.
Lee
Larisse K
LK
Division of Vascular Surgery, New York-Presbyterian Hospital, Cornell University and Weill Medical College, New York, NY 10021, USA.
Faries
Peter L
PL
D015901:Angiography, Digital Subtraction; D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D003952:Diagnostic Imaging / Q000379:methods*; D004195:Disease Models, Animal; D005548:Foreign-Body Migration / Q000175:diagnosis; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D019028:Magnetic Resonance Imaging, Cine; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012680:Sensitivity and Specificity; D015607:Stents; D013927:Thrombosis / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex