Key result
4D CT achieves ~100% sensitivity for detecting endoleaks after complex endovascular aortic repair.
Why the study?
Other modalities, most often conventional CTA, sometimes fail to fully characterize endoleaks in advanced endovascular aortic repair.
Does 4D CT accurately detect and characterize endoleaks in patients who have undergone complex branched or fenestrated endovascular aortic repair?
Observational (n=13)
No
Does 4D CT accurately detect and characterize endoleaks in patients who have undergone complex branched or fenestrated endovascular aortic repair?
4D CT provides an effective adjunctive imaging modality with excellent diagnostic yield for evaluating ambiguous or recurrent endoleaks following complex endovascular aortic repair.
May support 4D CT as adjunct for ambiguous endoleaks after complex EVAR; leaves open need for prospective validation.
OBJECTIVES: To assess the performance of dynamic or 4D CT in characterizing endoleaks in advanced endovascular aortic repair (branched and fenestrated) when other modalities fail to fully characterize the leak, most often conventional CTA. METHODS: , with anywhere between 10 and 40 iterations performed every 2 s. These settings were adjusted depending on graft characteristics and type of endoleak suspected. The scans were assessed for their ability to detect the endoleak (sensitivity), and further to characterize the endoleak by type and subtype (specificity). RESULTS: Overall sensitivity in 16 scans for endoleak detection was 100%. There was a specificity of 87.5% for determining the type of endoleak (14/16). These results included two studies that were inconclusive and repeated due to technical difficulties. In patients where a specific subtype was not established, the leak was localized to the appropriate target vessel. Average dose for the 4D CT was 4724 mGy*cm (1108-11069), with the outlining higher dose scans secondary to higher iterations in those scans. CONCLUSIONS: 4D CT is a useful adjunctive tool in FB-EVAR surveillance with excellent sensitivity and specificity in characterizing endoleaks. This allows for accurate localization of leaks, which is critical for management planning.
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Tarulli et al. (2022) conducted an observational in Endoleak after advanced endovascular aortic repair (FB-EVAR) (n=13). 4D Computed Tomography (4D CT) was evaluated on Endoleak detection (sensitivity). 4D CT demonstrated 100% sensitivity for detecting endoleaks and 87.5% specificity for characterizing endoleak type in patients following complex endovascular aortic repair.
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