主动脉支架术后内漏CT诊断及分型
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• Site Graft-related or perigraft Noggraft-related or retrograde
Classification
White et al. J ENDOVASC SURG, 1998
Classification
Sze et al. Circ Cardiovasc Intervent, 2009
Artery phase
Delay phase
Summary
• Classification is important
• Endoleak classification : thoracic aortic dissection endovascular aortic repair
Lehmkuhl, et al. Radiology,2013,9
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
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
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
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) • 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
Imaging diagnose
• • • • CT DSA MRI Ultrasound
DSA
Gleason et al. Thoracic and Cardiovascular Surgery,2009
MRI
• blood-pool • time-resolved • cine
Pitton et al. AJR,2005
Research progress
Sommer et al. Radiology, 2012
Stolzmann et al. Radiology 2008
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)
Endoleaks after endovascular aortic Stent-Grafting: CT 来自百度文库iagnosis
Luo Song
Department of Medical Imaging, Jinling Hospital
Outline
• • • • • • Concept and history Cause Imaging diagnose Classification CT characters Summary
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
Classification
White et al. J ENDOVASC SURG, 1998
Classification
Sze et al. Circ Cardiovasc Intervent, 2009
Artery phase
Delay phase
Summary
• Classification is important
• Endoleak classification : thoracic aortic dissection endovascular aortic repair
Lehmkuhl, et al. Radiology,2013,9
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
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
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
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) • 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
Imaging diagnose
• • • • CT DSA MRI Ultrasound
DSA
Gleason et al. Thoracic and Cardiovascular Surgery,2009
MRI
• blood-pool • time-resolved • cine
Pitton et al. AJR,2005
Research progress
Sommer et al. Radiology, 2012
Stolzmann et al. Radiology 2008
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)
Endoleaks after endovascular aortic Stent-Grafting: CT 来自百度文库iagnosis
Luo Song
Department of Medical Imaging, Jinling Hospital
Outline
• • • • • • Concept and history Cause Imaging diagnose Classification CT characters Summary
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