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(Radiology. 2000;215:414-420.)
© RSNA, 2000

Vascular and Interventional Radiology

Treatment of Leaks after Endovascular Repair of Aortic Aneurysms1

Johannes Görich, MD, Norbert Rilinger, MD, Roman Sokiranski, MD, Stefan C. Krämer, MD, Cengiz Ermis, MD, Ansgar Schütz, MD, Hans-Jürgen Brambs, MD, Joachim Söldner, MD, Werner Kaiser, MD, Ludger Sunder-Plassmann, MD and Reinhard Pamler, MD

1 From the Departments of Radiology (J.G., N.R., R.S., S.C.K., C.E., A.S., H.J.B.) and Thoracic and Vascular Surgery (L.S.P., R.P.), University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany; and the Department of Diagnostic and Interventional Radiology, University of Jena, Germany (J.S., W.K.). Received May 29, 1998; revision requested July 16; final revision received September 14, 1999; accepted September 24. Address correspondence to J.G.

PURPOSE: To evaluate leaks after the endovascular repair of aortic aneurysms and treat them with occlusive therapy.

MATERIALS AND METHODS: Seventy patients (11 women, 59 men), aged 26–82 years (mean, 69.2 years), underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Indications were traumatic pseudoaneurysms (n = 5) or arteriosclerotic aneurysms (n = 65). Aneurysms were thoracic (n = 5) or infrarenal (n = 65). To exclude the possibility of leaks, spiral computed tomography (CT) was performed at 3-month intervals. Patients with leaks that persisted unchanged longer than 3 months were referred for angiography and occlusive therapy.

RESULTS: At CT, 21 leaks were identified in 17 of 70 patients (24%). Only 11 of those 17 patients (65%) had leaks identified with conventional aortography. Selective angiography, however, depicted all of these. Eighteen of 21 leaks proved amenable to occlusive treatment: surgery (n = 1), further stent implantation (n = 4), or embolization (n = 13). In one leak, spontaneous occlusion occurred after 3 months. Two leaks in either the iliolumbar or the median sacral artery were inaccessible; one remained untreated, and the other was unsuccessfully treated. Mean follow-up of occlusive therapy was 6.8 months (range, 2–14 months).

CONCLUSION: Successful occlusion of perigraft leaks is feasible in most cases and can be performed without major complications.

Index terms: Aneurysm, aortic, 56.731, 56.732, 94.1222, 94.731, 94.732, 98.1222, 98.12915, 98.731, 98.732 • Aorta, angiography, 94.1222, 94.1225, 98.1222, 98.1225 • Aorta, CT, 94.12915, 98.12915 • Aorta, grafts and prostheses, 56.1268, 94.1268, 98.1268 • Aorta, interventional procedures, 94.1264, 94.1268, 98.1264, 98.1268 • Aortography, 94.1211, 98.1211 • Grafts, interventional procedures




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