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Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis.
Katahashi, Kazuto; Sano, Masaki; Takehara, Yasuo; Inuzuka, Kazunori; Sugiyama, Masataka; Alley, Marcus T; Takeuchi, Hiroya; Unno, Naoki.
Afiliação
  • Katahashi K; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Sano M; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Takehara Y; Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
  • Inuzuka K; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Sugiyama M; Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Alley MT; Department of Radiology, Stanford University, Palo Alto, Calif.
  • Takeuchi H; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Unno N; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: unno@hama-med.ac.jp.
J Vasc Surg ; 70(1): 107-116.e1, 2019 07.
Article em En | MEDLINE | ID: mdl-30792053
OBJECTIVE: The objective of this study was to investigate the hemodynamic parameters of type II endoleaks (T2ELs) to predict sac expansion using four-dimensional flow-sensitive magnetic resonance imaging (4D-flow MRI) analysis. METHODS: Patients who underwent endovascular aneurysm repair (EVAR) and were diagnosed with a T2EL were included in the study. Using 4D-flow MRI at 7 days, the peak flow velocity and amplitude of dynamics of blood flow per minute were measured in each T2EL vessel. The peak flow velocity was defined as the maximum of the absolute value of the blood flow velocity. The amplitude of dynamics of blood flow in the tributary arteries was defined as the sum of the absolute values of the inflow and outflow volume in each vessel. The amplitude of dynamics of blood flow in the tributary arteries per sac was calculated in each sac. The aneurysm sac diameter was measured by computed tomography (CT) at 1 year. The patients were divided into two groups according to the presence or absence of sac expansion. RESULTS: Of 155 patients who underwent EVAR, both CT angiography and 4D-flow MRI were performed in 107 patients at 7 days after EVAR. Among them, 39 (36.4%) were found to have a T2EL, of whom 28 were re-evaluated with CT angiography and 4D-flow at 1 year; 7 patients had expanding sacs (expanding group), whereas 21 had nonexpanding sacs (not-expanding group). At 7 days, 28 patients had 80 T2EL vessels detected by 4D-flow MRI, of which 39 vessels (48.8%) had stopped flowing at 1 year (transient vessels); 41 vessels (51.3%) had sustained flow (persistent vessels). The persistent vessels had significantly larger peak flow velocity and amplitude of dynamics of blood flow. The comprehensive analysis of T2EL vessels per sac identified that the amplitude of dynamics of blood flow in the tributary arteries per sac was significantly higher in the expanding group than in the not-expanding group. A receiver operating characteristic curve analysis revealed that the sensitivity and specificity of sac enlargement at a cutoff value of 3750 mm3/min were 85.7% and 76.2%, respectively. CONCLUSIONS: The fate of aneurysm sacs with T2ELs after EVAR has remained difficult to predict. A comprehensive analysis of concurrent multiple T2EL vessels using 4D-flow MRI analysis may enable prediction of the sac expansion after EVAR.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Aorta / Imageamento por Ressonância Magnética / Aneurisma da Aorta Abdominal / Implante de Prótese Vascular / Imagem de Perfusão / Endoleak / Procedimentos Endovasculares / Hemodinâmica Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Japão País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Aorta / Imageamento por Ressonância Magnética / Aneurisma da Aorta Abdominal / Implante de Prótese Vascular / Imagem de Perfusão / Endoleak / Procedimentos Endovasculares / Hemodinâmica Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Japão País de publicação: Estados Unidos