Dynamic Volumetric Computed Tomography Angiography Is a Preferred Method for Unclassified Endoleaks by Conventional Computed Tomography Angiography After Endovascular Aortic Repair

Figure 1. Flow chart of inclusion and exclusion criteria. C‐CTA indicates conventional computed tomography angiography; DV‐CTA, dynamic volumetric computed tomography angiography; EVAR, endovascular aortic repair.

Figure 2. Endoleak detected by conventional CTA in a 72‐year‐old man after EVAR at the 6‐month follow‐up was not differentiated between type I/III and type II endoleaks. A, Cross‐sectional image indicates the obvious endoleak (arrow) in the aneurysm after EVAR. B, Multiplanar reconstruction image of a coronal section shows a large amount of endoleak (circle) with being incapable of classifying the endoleak type. C, The 3D image shows the endoleaks (circle) and the suspicious vessels supplying the endoleaks (arrow). CTA indicates computed tomography angiography; EVAR, endovascular aortic repair.

Figure 3. The culprit vessel was evaluated by DV‐CTA to confirm the type II endoleak. A, A 3D image at 22 s shows the branch of the right hypogastric artery (arrow) but not the endoleak. B, A 3D image at 28 s shows the ILA (arrowhead) connected with a branch of the right hypogastric artery (arrow) with no sign of endoleak. Therefore, a type I endoleak was excluded. C, A 3D image at 40 s shows the endoleaks (circle) supplied by the ILA (arrowhead), thus indicating a type II endoleak. The arrow indicates the right hypogastric artery. DV‐CTA indicates dynamic volumetric computed tomography angiography; ILA, iliolumbar artery.

Figure 4. Reintervention for the type II endoleak identified by the DV‐CTA. A, The endoleak (circle) was confirmed by the angiogram in the ILA (arrow). B, The endoleak disappeared after the embolization coil (arrowhead) was placed in the ILA (arrow). C, The endoleak was not visualized even when the angiogram was in the superior mesenteric artery (arrow). The arrowhead indicates the embolization coil. DV‐CTA indicates dynamic volumetric computed tomography angiography; ILA, iliolumbar artery.

Figure 5. No endoleak was detected by the conventional CTA at the 6‐month follow‐up after reintervention. A and B, Cross‐section and multiplanar reconstruction images both indicate no endoleak in the aneurysm and embolization coil in the ILA (arrowhead). C, The 3D image shows an embolization coil in the ILA (arrowhead) and no endoleak outside of the stent‐graft (circle). CTA indicates computed tomography angiography; ILA, iliolumbar artery.