title: Intraoperative DynaCT detection and immediate correction of a type Ia endoleak following endovascular repair of abdominal aortic aneurysm.
abstract: Reintervention following endovascular aneurysm repair (EVAR) is required in up to 10% of patients at 30 days and is associated with a demonstrable risk of increased mortality. Completion angiography cannot detect all graft-related anomalies and computed tomographic angiography is therefore mandatory to ensure clinical success. Intraoperative angiographic computed tomography (DynaCT; Siemens, Germany) utilizes cone beam reconstruction software and flat-panel detectors to generate CT-like images from rotational angiographic acquisitions. We report the intraoperative use of this novel technology in detecting and immediately treating a proximal anterior type Ia endoleak, following an endovascular abdominal aortic repair, which was not seen on completion angiography. Immediate evaluation of cross-sectional imaging following endograft deployment may allow for on-table correction of clinically significant stent-related complications. This should both improve technical success and minimize the need for early secondary intervention following EVAR.
authors.affiliation: St George's Regional Vascular Institute, St James Wing, St. Georges Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Lukla
authors.initials: L
authors.lastname: Biasi
authors.forename: Tahir
authors.initials: T
authors.lastname: Ali
authors.forename: Robert
authors.initials: R
authors.lastname: Hinchliffe
authors.forename: Rob
authors.initials: R
authors.lastname: Morgan
authors.forename: Ian
authors.initials: I
authors.lastname: Loftus
authors.forename: Matt
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*