Leakages after endovascular repair of aortic aneurysms: classification based on findings at CT, angiography, and radiography.

ABSTRACT

PURPOSE: To ascertain whether the configuration and location of leakages identified at computed tomography (CT) could provide evidence of their angiographically and fluoroscopically confirmed causes. MATERIALS AND METHODS: Fifty patients aged 26-79 years underwent endovascular repair of traumatic (n = 4) or arteriosclerotic (n = 46) aortic aneurysms (four thoracic, 46 infrarenal). Radiographic examinations in three planes and helical CT were performed 1 week after implantation and every 3 months thereafter. Angiography was performed when there was evidence of a leakage at CT. RESULTS: CT demonstrated evidence of leakages in 13 patients. Broad-based leakages immediately adjacent to the prosthesis were termed "perigraft leakages." If the area most affected by the leakage lay along the border of the aneurysm, then retrograde leakages were apparent at angiography. If the leakage was ventral to the prosthesis, then its source was the inferior mesenteric artery; if it was dorsolateral, then it was supplied by either the lumbar arteries or the median sacral artery through the hypogastric artery. One circumferential leakage could not be evaluated adequately at CT or angiography. Radiography depicted a rupture of the stent mesh in the middle of the prosthesis. Selective angiography demonstrated all types of leakages and permitted CT classification. CONCLUSION: The cause of a leakage can be determined with CT on the basis of its configuration and location in the majority of cases.