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Endoleaks after endovascular aortic Stent-Grafting:CT diagnosisLuo SongDepartment of Medical Imaging,Jinling HospitalEndoleaks after endovascular a1OutlineConcept and historyCause Imaging diagnoseClassification CT charactersSummaryOutlineConcept and history2Concept and historyIn 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 endoleakConcept and historyIn 1991,th3Concept and historyWhites group then suggested a classification nomenclature based on time and site of occurrenceIn 1998,White et al revised their endoleak classification scheme again into 4 distinct types and an additional type(endotension)White et al.J ENDOVASC SURG,1998Concept and historyWhites gro4Concept and historyEndotension:there is demonstrable pressure within a sac but no endoleak identifiedIn 2002 a consensus conference was held on endoleaks and endotension after EVAR,and a classification scheme was formalizedConcept and historyEndotension5Veith FJ et al.J Vasc Surg,2002Veith FJ et al.J Vasc Surg,6景在平等，中国实用外科杂志，2002景在平等，中国实用外科杂志，20027CauseProximalDistalStent-graftBranch vesselsCauseProximal8Clinicalaortic-related mortalityreoperationreinterventionIncidence rate:between 12%and 20%Clinicalaortic-related mortali9Imaging diagnoseCTDSAMRIUltrasoundImaging diagnoseCT10DSAGleason et al.Thoracic and Cardiovascular Surgery,2009 DSAGleason et al.Thoracic and11MRIblood-pooltime-resolvedcine Pitton et al.AJR,2005 MRIblood-poolPitton et al.AJR12UltrasoundOperator expertiseBody habitusBowel gasThe air within the lungTEEIntravascular ultrasoundUltrasoundOperator expertise13ClassificationTime Within 30 days:primary or early Occurring later:secondary,delayed,or lateSite Graft-related or perigraft Noggraft-related or retrogradeClassificationTime14White et al.J ENDOVASC SURG,1998ClassificationWhite et al.J ENDOVASC SURG,15ClassificationSze et al.Circ Cardiovasc Intervent,2009ClassificationSze et al.Circ 16ClassificationClassification17TypeFlow from either the proximal or distalThe most common typeTypeFlow from either the prox18Type Retrograde aortic branch vessel blood flowType Retrograde aortic branch19The left subclavian arteryThe left subclavian artery20Type Structural failure with the stent graftHoles in the stentgraft fabric,Stent-graft fracturesJunctional separationsType Structural failure with 21AngularAngular22Type From the pores seep through and into the excluded segment of aortaEarlier generation stent-graftsType From the pores seep thro23Artery phaseDelay phaseArtery phaseDelay phase24SummaryClassification is importantEndoleak classification:thoracic aortic dissection endovascular aortic repair SummaryClassification is impor25Lehmkuhl,et al.Radiology,2013,9 Lehmkuhl,et al.Radiology,20126Research progressSommer et al.Radiology,2012Research progressSommer et al27Stolzmann et al.Radiology 2008Stolzmann et al.28ThanksThanks！Thanks！29
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