title: Application of color-coded quantitative digital subtraction angiography in predicting the outcomes of immediate type I and type III endoleaks.
abstract: Immediate type I and type III endoleaks after endovascular aneurysm repair (EVAR) could be persistent or temporary. Reintervention is necessary for persistent ones. Color-coded quantitative digital subtraction angiography (CQDSA) could provide a quantitative evaluation of the endoleak hemodynamics. We aimed to use CQDSA to quantify immediate type I and type III endoleaks after EVAR and to find a practical way to predict their outcomes.
  
  
  
  Between January 2012 and December 2014, 485 consecutive patients with abdominal aortic aneurysms underwent EVAR at our institution. Thirty-five patients (31 men, four women) with slight immediate type I and type III endoleaks after EVAR were recruited in the prospective observational nested case-control study. After at least 6 months of follow-up, these patients were divided into two groups based on endoleak-related adverse events. Their final intraprocedure DSA images were collected and converted into a single polychromatic image for CQDSA measurements. The parameter time to peak (TTP) of the selected regions of interest in the endoleak area and a reference area at the same latitude within the stent graft were derived from the time-intensity curve. A receiver operating characteristic curve was generated to test the ability of TTP to predict endoleak-related adverse events and to identify the optimal cutoff value.
  
  
  
  Finally, two groups were identified: 12 patients with endoleak-related adverse events and 23 patients without endoleak-related adverse events. Median follow-up time for all patients was 24.0 months. Age, gender, and comorbidity were similar in these two groups. TTP was significantly lower in patients with endoleak-related adverse events (P = .002). The risk of endoleak-related adverse events was significantly higher in patients with mixed-type endoleak than in those with simple-type endoleak (P = .003). According to the receiver operating characteristic curves, TTP ≤5 seconds reached the maximal sum of sensitivity and specificity (sensitivity, 91.67%; specificity, 69.57%). Logistic regression analysis confirmed that TTP ≤5 seconds (P = .016) and mixed-type endoleak (P = .044) were associated with higher risk of endoleak-related adverse events.
  
  
  
  CQDSA could help predict the outcomes of immediate type I or type III endoleaks after EVAR. TTP ≤5 seconds and mixed-type endoleak were two potential predictors of endoleak-related adverse events. This approach may offer an objective assessment of such immediate endoleaks and reference for immediate reintervention or conservative therapy.
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
authors.forename: Zijie
authors.initials: Z
authors.lastname: Su
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China. Electronic address: shizhenyumax@163.com.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Fu
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
authors.forename: Yonggang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
authors.forename: Baolei
authors.initials: B
authors.lastname: Guo
authors.affiliation: Siemens Healthcare, China, Shanghai, China.
authors.forename: Kaiyi
authors.initials: K
authors.lastname: Huang
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019540:Area Under Curve; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D016022:Case-Control Studies; D002681:China; D003116:Color; D057867:Endoleak / Q000000981:diagnostic imaging* / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome