title: Identification of predictive CT angiographic factors in the development of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms.
abstract: OBJECTIVE
  An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR).
  
  
  METHODS
  Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n = 80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n = 50). Statistical analysis comprised a univariate and multivariate analysis.
  
  
  RESULTS
  Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4 ± 3.8 mm; HRG 23.6 ± 2.5 mm; p = 0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7 ± 18.0%; HRG 25.3 ± 17.5%; p = 0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3%; HRG 92.0%; p = 0.003) and their diameter (LRG 3.3 ± 0.7 mm; HRG 3.8 ± 0.9 mm; p = 0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7 ± 1.4; HRG 3.6 ± 1.2; univariate: p = 0.01; multivariate: p = 0.006) as well as their diameter (LRG 2.1 ± 0.4 mm; HRG 2.4 ± 0.4 mm; univariate: p < 0.001; multivariate: p = 0.006) were highly significantly associated with the development of type 2 endoleaks of the HRG.
  
  
  CONCLUSIONS
  The most important predictive factors for the development of high-risk type 2 endoleaks were mainly the number and the diameter of the LAs which perfused the AAA.
  
  
  CONCLUSIONS
  • This study is a very detailed and comprehensive analysis of the value of various CT parameters as potential predictors of the clinical outcome of type 2 endoleaks after EVAR. • Anatomical as well as thrombus-specific parameters were unsuitable as predictors. • The most important predictive factors were mainly the number and the diameter of the LAs which perfused the AAA.
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: D
authors.initials: D
authors.lastname: Löwenthal
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: L
authors.initials: L
authors.lastname: Herzog
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: B
authors.initials: B
authors.lastname: Rogits
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: K
authors.initials: K
authors.lastname: Bulla
authors.affiliation: Biometry and Medical Informatics, University Magdeburg.
authors.forename: S
authors.initials: S
authors.lastname: Weston
authors.affiliation: General, Visceral and Vascular Surgery, University Magdeburg.
authors.forename: F
authors.initials: F
authors.lastname: Meyer
authors.affiliation: General, Visceral and Vascular Surgery, University Magdeburg.
authors.forename: Z
authors.initials: Z
authors.lastname: Halloul
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: M
authors.initials: M
authors.lastname: Pech
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: J
authors.initials: J
authors.lastname: Ricke
authors.affiliation: Radiology and Nuclear Medicine, University Magdeburg.
authors.forename: O
authors.initials: O
authors.lastname: Dudeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003287:Contrast Media; D057867:Endoleak / Q000000981:diagnostic imaging*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol