HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sawhney, R. Articles by Gordon, R. L. Search for Related Content PubMed PubMed Citation Articles by Sawhney, R. Articles by Gordon, R. L.

Analysis of Initial CT Findings after Endovascular Repair of Abdominal Aortic Aneurysm¹

¹ From the Depts of Radiology (R.S., R.K.K., S.D.W., D.E.R., J.M.L., J.Y., M.W.W., R.L.G.) and Surgery (T.A.M.C., C.J.C., L.M.R., J.J., R.M.F.), Univ of California, San Francisco. From the 1998 RSNA scientific assembly. Received Apr 28, 2000; revision requested Jun 12; revision received Dec 18; accepted Jan 16, 2001. Address correspondence to R.S., Dept of Interventional Radiology (114), San Francisco Veterans Administration Medical Ctr, 4150 Clement St, San Francisco, CA 94121 (e-mail: sawhney.rajiv@sanfrancisco.va.gov).

	ABSTRACT

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
PURPOSE: To determine the spectrum and frequency of specific computed tomographic (CT) findings in the acute period after endovascular repair of abdominal aortic aneurysm (AAA).

MATERIALS AND METHODS: CT images obtained 1–3 days after endograft placement were evaluated in 88 patients. The images were analyzed for stent position, appearance of endograft components, perigraft leak, and postoperative findings including air and acute thrombus within the aneurysm and air surrounding the femoral-femoral bypass graft. Findings that could be misinterpreted as perigraft leak were evaluated.

RESULTS: Fifteen (17%) of 88 patients had perigraft leak in the acute postoperative period. The bare segment of the proximal self-expanding stent covered one or both renal arteries in 54 (61%) patients. One patient had CT evidence of renovascular compromise. Postoperative air was within the aneurysmal sac in 51 (58%) patients and surrounded the femoral-femoral bypass graft in 67 (94%) of 71 patients in whom the grafts were evaluated with CT. Mottled attenuation within the aneurysmal sac was seen in 50 (57%) patients. Forty-six (52%) patients had calcifications within longstanding thrombus. In 31 (35%) patients, findings that could have been misinterpreted as perigraft leak were identified.

CONCLUSION: Accurate analysis of CT findings after endovascular AAA repair requires careful review of all available CT images (preprocedural and pre- and postcontrast) and clear understanding of specific stent-graft components and placement.

Index terms: Aneurysm, abdominal, 981.73 • Aneurysm, aortic, 981.73 • Aorta, CT, 981.12911, 981.12912, 981.12915 • Aorta, grafts and prostheses, 981.1268 • Interventional procedures, complications, 981.1268, 981.458

	INTRODUCTION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Early experience with the placement of stent-grafts for the treatment of abdominal aortic aneurysm (AAA) shows this endovascular approach to be a promising alternative to open surgical procedures (1–8). This is especially applicable in patients who have major comorbid medical conditions.

The goal of endovascular repair of AAA is to exclude the aneurysmal sac from circulation without using laparotomy, by accurately placing a stent-graft by means of the transfemoral approach. The effectiveness of device placement is initially evaluated with intraoperative angiography. However, spiral computed tomography (CT) is the preferred method of follow-up, since CT depicts many diagnostic findings, including the stent-graft components, the aneurysmal sac, and the presence or absence of perigraft flow (9–11). Importantly, CT allows for continued noninvasive follow-up.

The purpose of this study was to determine the spectrum and frequency of CT findings in the acute period 1–3 days following endovascular repair of infrarenal AAAs with an institution-specific custom-made stent-graft.

	MATERIALS AND METHODS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
In a high-risk patient group with a predicted surgical mortality rate of greater than 10%, aortic stent-grafts were electively placed in 88 patients (83 men and five women; mean age, 75 years; age range, 58–81 years) by using a physician-investigator IDE, or Investigational Device Exception, from the U.S. Food and Drug Administration and a protocol approved by the University of California, San Francisco, committee on human research. Informed consent was obtained in all cases per the protocol after the nature of the procedure had been fully explained. All patients were considered to be at high risk for conventional AAA surgery because of comorbid conditions, most commonly severe cardiopulmonary disease. The patients had a AAA that was either at least 5 cm in diameter or rapidly expanding (>7-mm growth in 6 months). Because these patients were not considered surgical candidates, they were offered transfemoral endovascular repair per the protocol.

Many of the preprocedural CT examinations were performed at various referring institutions; therefore, no set preprocedural protocol was followed. All preprocedural angiography was performed at our institution by using calibrated measuring catheters.

The stent-graft and delivery system used at our institution have previously been described in detail (8,12). In brief, the device consists of a fabric conduit (Cooley Verysoft; Meadox Medicals, Oakland, NJ) supported by self-expanding stainless steel stents (Gianturco-Rösch Z; Cook, Bloomington, Ind) proximally and distally. The device configuration for AAA treatment is either an aortic tube graft or an aortouniiliac tapered stent-graft with contralateral common iliac occlusion and conventional cross-femoral bypass; the choice depends on the anatomy of the AAA. The contralateral iliac occluder device is a short stent-graft constructed by using the self-expanding stainless steel stent with one end of the graft sewn closed. A long self-expanding stent (Wallstent; Boston Scientific, Natick, Mass) is placed within the tapered portion of the stent-graft for support.

After stent-graft placement, an intraoperative digital subtraction angiogram was obtained by using a digital mobile imaging system (OEC 9600; OEC Medical Systems, Salt Lake City, Utah) to evaluate device position and patency and aneurysm exclusion. Although the device position was thought to be accurate, and device patency and aneurysm exclusion were thought to be adequate on the basis of the angiographic findings, imaging with mobile digital systems is not thought to be optimal; therefore, follow-up CT was required.

Follow-up CT was performed with a spiral scanner (HiSpeed CT/i; GE Medical Systems, Milwaukee, Wis) and a standardized protocol consisting of nonenhanced transverse imaging from the level of the diaphragm to the top of the sacroiliac joints, with 7-mm collimation and 7-mm table speed, and of contrast material–enhanced spiral imaging from above the celiac axis through the common femoral arteries, with 3-mm collimation, a 1.5–2.0 pitch, and a single breath hold. Contrast-enhanced imaging was performed 20–40 seconds after the infusion of 150 mL of 320–350 mg of iodine per milliliter nonionic iodinated contrast material (Oxilan-350; Cook Imaging, Bloomington, Ind) at 2 mL/sec via an antecubital vein. The scanning delay was determined with the appearance of a 30-mL test bolus in the field of interest.

CT scans were obtained 1–3 days after the endovascular procedure. In all 88 patients, CT images were without obscuring artifacts from stent-graft components. All CT scans were retrospectively analyzed by means of consensus reading by three experienced radiologists (R.S., R.K.K., S.D.W.). Specific findings of interest including the presence or absence of perigraft leak and type of leak, position of the proximal stent relative to the renal arteries, appearance of stent-graft components, and postoperative appearance of the aneurysmal sac and femoral-femoral bypass graft were evaluated.

Type 1 endoleaks are caused by separation of the device from the arterial wall, resulting in leaks originating at attachment sites. Type 2 endoleaks are caused by retrograde flow into the aneurysmal sac via branch vessels (ie, the lumbar arteries and inferior mesenteric artery). Type 3 endoleaks result from fabric tears, and type 4 endoleaks are due to fabric porosity.

In addition, CT findings that could have been misinterpreted as perigraft leak were identified. These were defined as findings of equivocal high attenuation or mixed attenuation outside the stent-graft lumen on follow-up contrast-enhanced scans that at initial viewing could have been interpreted as possible endoleak. These findings ultimately required careful image-to-image comparison between images obtained before and after contrast material administration or preprocedural scans before leak could absolutely be excluded.

	RESULTS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
The acute CT findings after stent-graft placement are summarized in the Table. Unequivocal perigraft leak was identified on the initial postprocedural CT scan in 15 (17%) of 88 patients. In all of these cases, an abnormal collection was clearly located outside the lumen of the device components and had attenuation similar to that of the contrast material within the lumen of the graft (Fig 1). There were three type 1 leaks, nine type 2 leaks, and three mixed type 1 and 2 leaks. No type 3 or 4 leaks were identified at CT.

View larger version (134K): [in this window] [in a new window] [Download PPT slide]   Figure 1. Transverse postcontrast spiral CT image demonstrates a contrast material collection (arrow) within the aneurysmal sac; the collection is clearly external to the graft lumen (arrowhead) and represents true perigraft leak.

View larger version (127K): [in this window] [in a new window] [Download PPT slide]   Figure 2a. Calcium displaced from the aortic wall requires review of the nonenhanced CT scan to unequivocally exclude perigraft leak. (a) Transverse postcontrast spiral CT image obtained after stent-graft placement shows highly attenuating material (arrow) within the aneurysmal sac. (b) Transverse precontrast CT image is used to confirm that the area of high attenuation definitively represents preexistent calcium (arrow) displaced from the aortic wall and not perigraft leak.

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 2b. Calcium displaced from the aortic wall requires review of the nonenhanced CT scan to unequivocally exclude perigraft leak. (a) Transverse postcontrast spiral CT image obtained after stent-graft placement shows highly attenuating material (arrow) within the aneurysmal sac. (b) Transverse precontrast CT image is used to confirm that the area of high attenuation definitively represents preexistent calcium (arrow) displaced from the aortic wall and not perigraft leak.

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 3a. Mottled appearance within the aneurysmal sac after endovascular AAA repair. (a) Transverse initial postprocedural spiral CT scan shows contrast material within the stent-graft lumen and a low-attenuating mottled appearance (arrowheads) surrounding the stent-graft, which represents acute thrombus within the previously patent lumen. (b) Transverse preprocedural CT scan shows the corresponding contrast material-filled lumen (arrowheads) of the AAA.

View larger version (105K): [in this window] [in a new window] [Download PPT slide]   Figure 3b. Mottled appearance within the aneurysmal sac after endovascular AAA repair. (a) Transverse initial postprocedural spiral CT scan shows contrast material within the stent-graft lumen and a low-attenuating mottled appearance (arrowheads) surrounding the stent-graft, which represents acute thrombus within the previously patent lumen. (b) Transverse preprocedural CT scan shows the corresponding contrast material-filled lumen (arrowheads) of the AAA.

View larger version (158K): [in this window] [in a new window] [Download PPT slide]   Figure 4. Transverse postprocedural spiral CT image shows a column of contrast material within a column of contrast material caused by protrusion of the supporting self-expanding stent (arrow) into the untapered portion of the stent-graft (arrowhead).

View larger version (130K): [in this window] [in a new window] [Download PPT slide]   Figure 5. Transverse postprocedural spiral CT image demonstrates contrast material within folds of graft material in the unsupported portion of the stent-graft (arrow), which produces an undulating, or cloverleaf, appearance rather than the expected smooth circular appearance.

One or both renal arteries were covered by the bare portion of the proximal stent in 54 (61%) of the 88 patients. Only one patient had unexpected CT findings consistent with a focal infarct of the lower pole of the right kidney. There were no clinical consequences 3 days after stent-graft placement. Of note, in one patient, multiple right renal arteries originating in the region of the distal aorta were intentionally covered by the graft to adequately exclude the AAA. This patient had evidence of infarction of the upper and middle pole of this kidney; however, the patient also had no clinical sequelae in the immediate postoperative period.

Other acute findings included air trapped in the aneurysmal sac in 51 (58%) of the 88 patients and air surrounding the graft in 67 (94%) of the 71 patients with femoral-femoral bypass grafts that were evaluated with CT.

	DISCUSSION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Several endovascular systems have been used to treat AAA, and the initial clinical results have been described in the literature (4–7,13,14). In our series, unequivocal perigraft perfusion that manifested as abnormal perigraft collections of equal attenuation of intraluminal contrast material was seen in 17% of patients on the initial postprocedural CT scan. Our rate of perigraft perfusion compares favorably with the reported rates of perigraft flow (4,6,7,14–19). Certainly, follow-up CT is required to assess continued perigraft perfusion and the need for subsequent therapeutic intervention in these cases.

We identified several CT findings of interest, some of which are specific to the endovascular system used at our institution. Mottled attenuation surrounding the stent-graft was seen in 57% of the patients in our series. The exact cause of this increase in mottled attenuation is not certain. However, because it was present on the precontrast images and appeared to be confined to the previously patent lumen of the aneurysm, as seen on preprocedural CT images, we think it represented acute thrombosis within the aneurysm that was excluded by the stent-graft. This mottled appearance usually has attenuation lower than that of perigraft perfusion and therefore should not be mistaken for perigraft flow. Review of the precontrast scan is crucial.

Calcification within longstanding thrombus displaced from the aneurysmal wall was seen in more than 50% of patients. In many of these cases, the calcification was thin and curvilinear. However, in several cases, the appearance was thicker or smudged, and the interpretation of this highly attenuating material was not straightforward, since it resembled contrast material. Again, comparison with precontrast images was necessary for confident identification of this highly attenuating material as calcification within thrombus.

Two findings, contrast material–filled folds in the unsupported portion of the stent-graft and protrusion of the self-expanding stent into the untapered segment, are specific to the type of stent-graft used at our institution. Contrast material–filled folds in the unsupported portion of the stent-graft create an irregular appearance of the intraluminal contrast material on transverse scans, since contrast material within the folds of the graft material does not conform to the expected circular or nearly circular appearance of a contrast material–filled lumen. Rather, a cloverleaf appearance is seen in this region. In addition, protrusion of the self-expanding stent into the untapered segment of the stent-graft can have the unique appearance of a column of contrast material within a column of contrast material on transverse images.

A majority of the preceding findings were readily identified as acute thrombus, intrathrombic calcification, or findings secondary to the design of the stent-graft and therefore were not confused with possible perigraft perfusion. However, in 31 (35%) of the cases in our series, the initial interpretation of the contrast-enhanced CT scan was potentially equivocal for perigraft flow because of the appearance of some of the previously mentioned findings. In these cases, if one or more of those findings were not carefully compared with the precontrast or preprocedural CT findings, perigraft perfusion could not be definitely excluded.

In 54 (61%) patients, the bare segment of the proximal self-expanding stainless steel stent covered one or both renal arteries. Placement of the bare stent up to or even across the renal arteries is vital to ensure adequate proximal seal in such patients, who rarely have a long disease-free infrarenal neck. In the short term, it appears that the risk of renovascular compromise is low when the bare segment of the stent-graft is placed across one or both renal arteries, since only one patient in our series had evidence of unexpected renal infarct at initial postprocedural CT. There was no laboratory-based evidence of renal compromise in this patient in the acute setting. Similar findings have been reported by Duda et al (20).

Many patients had evidence of air trapped within the aneurysmal sac and surrounding the femoral-femoral bypass graft. These appear to be incidental postprocedural findings reflecting clinically unimportant air introduced during stent-graft deployment and surgical creation of the femoral-femoral bypass graft.

Several findings analyzed in this study relate specifically to our custom-made stent-graft and may not apply to U.S. Food and Drug Administration–approved stent-grafts at this time. However, investigators in clinical trials in progress are evaluating stent-grafts that rely on suprarenal fixation and have different support features. As such, we anticipate that some CT findings analyzed in our series may be seen on follow-up CT scans obtained in patients with other aortic stent-grafts. Certainly, the general conclusions underscored in this study regarding the need for full understanding of device design and accurate interpretation of preprocedural and precontrast comparison scans are applicable to all stent-grafts.

Another limitation of this study was that analysis was performed by using a consensus reading format. A better approach would have been independent reading by the three radiologists.

In summary, it appears that covering one or both of the renal arteries with the bare portion of a stent-graft, as is often necessary for a secure proximal seal, is of low risk for renovascular compromise in the acute setting, and postprocedural findings of air within the excluded aneurysm and adjacent to a cross-femoral bypass graft are common. Initial CT images obtained following endovascular repair of AAA show characteristic findings, some of which are specific to the design of the stent-graft used. Most of these findings are readily characterized and are not confused with perigraft flow. However, familiarity with stent-graft design and components is crucial. We found that head-to-head comparisons between contrast-enhanced images and precontrast or preprocedural images are necessary to definitively exclude perigraft perfusion in a substantial number of cases. It is clear that serial CT is important in following up and further understanding the initial findings described in this series, as well as in evaluating the mid- and long-term results of this newer technology.

	FOOTNOTES

 
T.A.M.C. holds licensed patent rights on endovascular aneurysm repair for Cook and Endovascular Technologies and consults for both companies.

Abbreviation: AAA = abdominal aortic aneurysm

Author contributions: Guarantors of integrity of entire study, R.S., R.K.K., S.D.W.; study concepts and design, R.S., R.K.K., S.D.W.; literature research, R.S.; clinical studies, R.S., R.K.K., S.D.W., T.A.M.C., J.M.L., L.M.R., J.Y., M.W.W., J.J., R.M.F., R.L.G.; data acquisition, R.S., R.K.K., S.D.W., D.E.R., T.A.M.C., C.J.C.; data analysis/interpretation, R.S., R.K.K., S.D.W.; manuscript preparation, definition of intellectual content, and editing, R.S.; manuscript revision/review and final version approval, R.S., R.K.K., S.D.W.

	REFERENCES

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 

1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5:491-499.[CrossRef][Medline]
2. Parodi JC. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg 1995; 21:549-557.[CrossRef][Medline]
3. Blum U, Langer M, Spillner G, et al. Abdominal aortic aneurysms: preliminary technical and clinical results with transfemoral placement of endovascular self-expanding stent-grafts. Radiology 1996; 198:25-31.[Abstract/Free Full Text]
4. Moore WS, Rutherford RB. Transfemoral endovascular repair of abdominal aortic aneurysm: results of the North American EVT phase 1 trial. J Vasc Surg 1996; 23:543-553.[CrossRef][Medline]
5. Chuter TAM, Risberg B, Hopkinson BR, et al. Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair. J Vasc Surg 1996; 24:655-666.[CrossRef][Medline]
6. Murphy KD, Richter GM, Henry M, Encarnacion CE, Le VA, Palmaz JC. Aortoiliac aneurysms: management with endovascular stent-graft placement. Radiology 1996; 198:473-480.[Abstract/Free Full Text]
7. Blum U, Voshage G, Lammer J, et al. Endoluminal stent-graft for infrarenal abdominal aortic aneurysms. N Engl J Med 1997; 336:13-20.[Abstract/Free Full Text]
8. Chuter TAM, Gordon RL, Reilly LM, et al. Abdominal aortic aneurysm in high-risk patients: short- to intermediate-term results of endovascular repair. Radiology 1999; 210:361-365.[Abstract/Free Full Text]
9. Rozenblit A, Marin ML, Veith FJ, Cynamon J, Wahl SI, Bakal CW. Endovascular repair of abdominal aortic aneurysm: value of postoperative follow-up with helical CT. AJR Am J Roentgenol 1995; 165:1473-1479.[Abstract/Free Full Text]
10. Golzarian J, Dussaussois L, Abada HT, et al. Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR Am J Roentgenol 1998; 171:329-331.[Abstract/Free Full Text]
11. Tillich M, Haussegger KA, Tiesenhausen K, Tauss J, Groell R, Szolar D. Helical CT angiography of stent-grafts in abdominal aortic aneurysms: morphological changes and complications. RadioGraphics 1999; 19:1573-1583.[Abstract/Free Full Text]
12. Yusuf SW, Whitaker SC, Chuter TA, et al. Early results of endovascular aortic aneurysm surgery with aortouniiliac graft, contralateral iliac occlusion, and femorofemoral bypass. J Vasc Surg 1997; 25:165-172.[CrossRef][Medline]
13. Kato N, Dake MD, Semba CP, et al. Treatment of aortoiliac aneurysms with use of single-piece tapered stent-grafts. J Vasc Interv Radiol 1998; 9:41-49.[Medline]
14. Uflacker R, Robison JG, Brothers TE, Pereira AH, Sanvitto PC. Abdominal aortic aneurysm treatment: preliminary results with the Talent stent-graft system. J Vasc Interv Radiol 1998; 9:51-60.[Medline]
15. Kato N, Semba CP, Dake MD. Embolization of perigraft leaks after endovascular stent-graft treatment of aortic aneurysms. J Vasc Interv Radiol 1996; 7:805-811.[Medline]
16. Golzarian J, Struyven J, Abada HT, et al. Endovascular aortic stent-grafts: transcatheter embolization of persistent perigraft leaks. Radiology 1997; 202:731-734.[Abstract/Free Full Text]
17. Dorffner R, Thurner S, Polterauer P, Kretschmer G, Lammer J. Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: complications and secondary radiologic intervention. Radiology 1997; 204:79-86.[Abstract/Free Full Text]
18. Naslund TC, Edwards WH, Neuzil DF, et al. Technical complications of endovascular abdominal aortic repair. J Vasc Surg 1997; 26:502-510.[CrossRef][Medline]
19. Holzenbein TJ, Kretschmer G, Dorffner R, et al. Endovascular management of "endoleaks" after transluminal infrarenal abdominal aneurysm repair. Eur J Vasc Endovasc Surg 1998; 16:208-217.[CrossRef][Medline]
20. Duda SH, Raygrotzki S, Wiskirchen J, et al. Abdominal aortic aneurysms: treatment with juxtarenal placement of covered stent-grafts. Radiology 1998; 206:195-198.[Abstract/Free Full Text]

This article has been cited by other articles:

				P. Stolzmann, T. Frauenfelder, T. Pfammatter, N. Peter, H. Scheffel, M. Lachat, B. Schmidt, B. Marincek, H. Alkadhi, and T. Schertler Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair: Detection with Dual-Energy Dual-Source CT Radiology, November 1, 2008; 249(2): 682 - 691. [Abstract] [Full Text] [PDF]

				R. Iezzi, A. R. Cotroneo, A. Filippone, F. Di Fabio, M. Santoro, and M. L. Storto MDCT Angiography in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Diagnostic Impact of Slice Thickness on Detection of Endoleaks Am. J. Roentgenol., December 1, 2007; 189(6): 1414 - 1420. [Abstract] [Full Text] [PDF]

				R. Iezzi, A. R. Cotroneo, A. Filippone, F. Di Fabio, F. Quinto, C. Colosimo, and L. Bonomo Multidetector CT in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Are Unenhanced and Delayed Phase Enhanced Images Effective for Endoleak Detection? Radiology, December 1, 2006; 241(3): 915 - 921. [Abstract] [Full Text] [PDF]

				J. W. Olin, J. A. Kaufman, D. A. Bluemke, R. O. Bonow, M. D. Gerhard, M. R. Jaff, G. D. Rubin, and W. Hall Atherosclerotic Vascular Disease Conference: Writing Group IV: Imaging Circulation, June 1, 2004; 109(21): 2626 - 2633. [Full Text] [PDF]

				H. E. Rodriguez, J. S. Matsumura, M. D. Morasch, R. K. Greenberg, and W. H. Pearce Abdominal Wall Hernias After Open Abdominal Aortic Aneurysm Repair: Prospective Radiographic Detection and Clinical Implications Vascular and Endovascular Surgery, May 1, 2004; 38(3): 237 - 240. [Abstract] [PDF]

				J. Golzarian, A. M. Rozenblit, M. P. Laks, and Z. J. Ricci Delayed Helical CT Acquisition in the Detection of Endoleak [letter] * Dr Rozenblit and colleagues respond: Radiology, January 1, 2004; 230(1): 299 - 300. [Full Text] [PDF]

				A. M. Rozenblit, M. Patlas, A. T. Rosenbaum, T. Okhi, F. J. Veith, M. P. Laks, and Z. J. Ricci Detection of Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysm: Value of Unenhanced and Delayed Helical CT Acquisitions Radiology, May 1, 2003; 227(2): 426 - 433. [Abstract] [Full Text] [PDF]

This Article Abstract Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sawhney, R. Articles by Gordon, R. L. Search for Related Content PubMed PubMed Citation Articles by Sawhney, R. Articles by Gordon, R. L.