主动脉支架术后内漏CT诊断及分型
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
Endoleaks after endovascular aortic Stent-Grafting: CT diagnosis
Luo Song
Department of Medical Imaging, Jinling Hospital
Outline
• Concept and history • Cause • Imaging diagnose • Classification • CT characters • Summary
White et al. J ENDOVASC SURG, 1998
Concept and history
• Endotension: there is demonstrable pressure within a sac but no endoleak identified
• In 2002 a consensus conference was held on endoleaks and endotension after EVAR, and a classification scheme was formalized
Veith FJ et al. J Vasc Surg , 2002
景在平等，中国实 用外科杂志，2002
Cause
• Proximal • Distal • Stent-graft • Branch vessels
Clinical
• aortic-related mortality • reoperation • reintervention • Incidence rate: between 12% and 20%
Concept and history
• In 1991, the first successful endovascular abdominal aortic repair(EVAR)
• In 1994, the first thoracic endovascular aortic repair(TEVAR)
Lehmkuhl, et al. Radiology,2013,9
Research progress
Sommer et al. Radiology, 2012
Stolzmann et al. Radiology 2008
Imaging diagnose
• CT • DSA • MRI • Ultrasound
DSA
Gleason et al. Thoracic and Cardiovascular Surgery,2009
• blood-pool • time-resolved • cine
MRI
Pitton et al. AJR,2005
Classification
TypeⅠ
• Flow from either the proximal or distal • The most common type
Type Ⅱ
• Retrograde aortic branch vessel blood flow
The left subclavian artery
• In 1996, White first suggested that this phenomenon of incomplete between the aortic wall and a stent-graft resulting in “paragraft flow” be termed endoleak
Ultrasound
• Operator expertise • Body habitus • Bowel gas • The air within the lung • TEE • Intravascular ultrasound
Classification
• Time Within 30 days: primary or early Occurring later: secondary, delayed, or late
• Site Graft-related or perigraft Noggraft-related or retrograde
Classification
White et al. J ENDOVASC SURG, 1998
Classification
Sze et al. Circ CarΒιβλιοθήκη Baiduiovasc Intervent, 2009
Concept and history
• White’s group then suggested a classification nomenclature based on time and site of occurrence
• In 1998, White et al revised their endoleak classification scheme again into 4 distinct types and an additional type (endotension)
Type Ⅲ
• Structural failure with the stent graft • Holes in the stentgraft fabric, • Stent-graft fractures • Junctional separations
Angular
Type Ⅳ
• From the pores seep through and into the excluded segment of aorta
• Earlier generation stent-grafts
Artery phase Delay phase
Summary
• Classification is important
• Endoleak classification : thoracic aortic dissection endovascular aortic repair
Luo Song
Department of Medical Imaging, Jinling Hospital
Outline
• Concept and history • Cause • Imaging diagnose • Classification • CT characters • Summary
White et al. J ENDOVASC SURG, 1998
Concept and history
• Endotension: there is demonstrable pressure within a sac but no endoleak identified
• In 2002 a consensus conference was held on endoleaks and endotension after EVAR, and a classification scheme was formalized
Veith FJ et al. J Vasc Surg , 2002
景在平等，中国实 用外科杂志，2002
Cause
• Proximal • Distal • Stent-graft • Branch vessels
Clinical
• aortic-related mortality • reoperation • reintervention • Incidence rate: between 12% and 20%
Concept and history
• In 1991, the first successful endovascular abdominal aortic repair(EVAR)
• In 1994, the first thoracic endovascular aortic repair(TEVAR)
Lehmkuhl, et al. Radiology,2013,9
Research progress
Sommer et al. Radiology, 2012
Stolzmann et al. Radiology 2008
Imaging diagnose
• CT • DSA • MRI • Ultrasound
DSA
Gleason et al. Thoracic and Cardiovascular Surgery,2009
• blood-pool • time-resolved • cine
MRI
Pitton et al. AJR,2005
Classification
TypeⅠ
• Flow from either the proximal or distal • The most common type
Type Ⅱ
• Retrograde aortic branch vessel blood flow
The left subclavian artery
• In 1996, White first suggested that this phenomenon of incomplete between the aortic wall and a stent-graft resulting in “paragraft flow” be termed endoleak
Ultrasound
• Operator expertise • Body habitus • Bowel gas • The air within the lung • TEE • Intravascular ultrasound
Classification
• Time Within 30 days: primary or early Occurring later: secondary, delayed, or late
• Site Graft-related or perigraft Noggraft-related or retrograde
Classification
White et al. J ENDOVASC SURG, 1998
Classification
Sze et al. Circ CarΒιβλιοθήκη Baiduiovasc Intervent, 2009
Concept and history
• White’s group then suggested a classification nomenclature based on time and site of occurrence
• In 1998, White et al revised their endoleak classification scheme again into 4 distinct types and an additional type (endotension)
Type Ⅲ
• Structural failure with the stent graft • Holes in the stentgraft fabric, • Stent-graft fractures • Junctional separations
Angular
Type Ⅳ
• From the pores seep through and into the excluded segment of aorta
• Earlier generation stent-grafts
Artery phase Delay phase
Summary
• Classification is important
• Endoleak classification : thoracic aortic dissection endovascular aortic repair