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Il Giornale Italiano di Radiologia Medica 2018 Maggio-Giugno;5(3):335-40

DOI: 10.23736/S2283-8376.18.00078-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Type II endoleaks in endovascular aortic repair: cone beam CT and automatic vessel detection to guide the embolization

Enrico M. FUMAROLA 1, Anna M. IERARDI 2 , Mario PETRILLO 2, Salvatore A. ANGILERI 2, Gianpaolo CARRAFIELLO 3

1 Dipartimento di Radiologia Diagnostica e Interventistica, Scuola di Specializzazione in Radiodiagnostica, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italia; 2 Dipartimento di Radiologia Diagnostica e Interventistica, Ospedale San Paolo, ASST Santi Paolo e Carlo, Milano, Italia; 3 Dipartimento di Radiologia Diagnostica e Interventistica, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italia


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BACKGROUND: Dual-phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) soft- ware are helpful tools for detecting arteries before planned endovascular interventions. The purpose of this study is to evaluate the usefulness of DP-CBCT and AVD software in guiding the trans-arterial embolization (TAE) of challenging T2 lumbar endoleaks (T2-L-EL).
METHODS: Ten patients with T2-L-EL were included in this study. The accuracy of DP-CBCT and the AVD software was defined by the ability to detect the endoleak and arterial feeding vessel, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software and the successful embolization of the endoleak. Clinical success was defined as the absence of recurrent endoleaks during follow-up and the stability of the sac diameter for persistent endoleaks. The total volume of iodinated contrast medium, overall procedure time, mean procedural radiation dose, and mean fluoroscopy time were recorded.
RESULTS: The EL was detected by DP-CBCT in all patients. The AVD software identified the feeding arterial branch in all cases. In one patient, the nidus of the endoleak was not reached due to the small caliber of the feeding artery, even though the software had clearly identified the vessel route. The mean contrast volume was 109 mL, the mean overall procedural time was 74.3 min. The mean procedural radiation dose was 140.97 Gy cm2, and the mean fluoroscopy time was 29.8 min.
CONCLUSIONS: The use of DP-CBCT and the AVD software is feasible and may facilitate successful embolization in challenging occult T2-L-EL with complex vasculature.


KEY WORDS: Embolization, therapeutic - Endoleak - Cone-beam computed tomography

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