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Type II Endoleak after Endoaortic Graft Implantation: Diagnosis with Helical CT Arteriography¹

¹ From the Departments of Radiology (V.C., A.M.R., J.C., Z.J.R., M.P.L.) and Surgery (F.J.V.), Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; and Department of Radiology, Hamilton General Hospital, East Hamilton, Ontario, Canada (M.P.). Received June 16, 2005; revision requested August 18; revision received September 9; accepted October 14; final version accepted December 15. Address correspondence to V.C. (e-mail: vichka17{at}hotmail.com).

Purpose: To retrospectively assess endoleak shapes and locations within aneurysms to differentiate type II from type I and type III endoleaks.

Materials and Methods: The institutional review board granted an exemption for this HIPAA-compliant study; patient informed consent was not required. A retrospective review of arterial phase helical computed tomographic (CT) studies and medical records was performed for 39 patients (29 men, 10 women; age range, 60–89 years; mean, 78.5 years) who had an endoleak after endoaortic graft implantation for treatment of abdominal aortic aneurysm and who subsequently underwent angiography (n = 25), surgery (n = 8), or long-term follow-up (n = 6) to classify their endoleak into a specific type. At CT, endoleak shape (tubular or nontubular) and location (central or peripheral) were recorded. An endoleak was classified as type II if it contained a peripheral tubular component (PTC) near the aortic wall, with or without an identifiable feeding vessel. Endoleaks without these features were classified as type I or III. The Fisher exact test was used to assess associations between CT findings and endoleak type.

Results: There were 22 type II and 17 type I or III endoleaks. CT enabled correct identification of 22 (100%) of 22 type II endoleaks, all of which contained a PTC. Of 17 type I or III endoleaks, only two (12%) contained a PTC and were misclassified as type II endoleaks; the remaining 15 (88%) were correctly classified. Overall, CT enabled correct identification of endoleaks as type II or type I or III in 37 (95%) of 39 patients. PTCs were significantly more common (P < .001) in type II than in type I or III endoleaks, with a sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 100%, 88.2%, 94.9%, 100%, and 91.7%, respectively.

Conclusion: A PTC is a statistically significant predictor of type II endoleak in most patients.

© RSNA, 2006

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