Download PDF
Rofo 2005; 177(1): 24-34
DOI: 10.1055/s-2004-813808
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Klassifikation und Therapie von Endolecks nach endovaskulärer Behandlung von abdominellen Aortenaneurysmen

Classification and Treatment of Endoleaks after Endovascular Treatment of Abdominal Aortic AneurysmsM. B. Pitton1 , W. Schmiedt2 , A. Neufang2 , C. Düber3 , M. Thelen1
  • 1Klinik für Radiologie (Direktor: Prof. Dr. M. Thelen), Klinikum der Johannes Gutenberg-Universität Mainz
  • 2Klinik für Herz-, Thorax- und Gefäßchirurgie (Direktor: Prof. Dr. C. Vahl), Klinikum der Johannes Gutenberg-Universität Mainz
  • 3Institut für Klinische Radiologie, Klinikum Mannheim gGmbH, Universitätsklinikum Mannheim (Direktor: Prof. Dr. C. Düber)
Further Information

Publication History

Publication Date:
19 January 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die vorliegende Arbeit beschreibt die derzeit gültige Klassifikation von Endolecks nach endovaskulärer Therapie von abdominellen Aortenaneurysmen. Sie gibt damit einen Überblick über die wesentlichen Probleme dieses endovaskulären Therapieverfahrens. Die korrekte Endoleckklassifizierung ist die wesentliche Voraussetzung für eine interdisziplinäre Befunddiskussion. Sie ist für die fachgerechte Therapieentscheidung unentbehrlich und sollte bei der Befundbeschreibung berücksichtigt werden. Unabhängig vom Prothesentyp und von Materialeigenschaften werden in der Literatur derzeit fünf Endolecktypen definiert: Verankerungsleckagen (Typ I), Leckagen durch Kollateralarterien (Typ II), Leckagen durch Defekte der Stentprothese (Typ III), Leckagen durch Materialporosität (Typ IV) und Endotension (Typ V). Die Endoleckursachen werden zusammenfassend dargestellt und Behandlungsmöglichkeiten aufgezeigt.

Abstract

This article describes the classification of endoleaks after endovascular treatment of abdominal aortic aneurysms, thereby summarizing the most important problems of this endovascular technique. The correct classification of endoleaks is a prerequisite for interdisciplinary discussion. It is indispensable for professional reporting of the pathological findings and for the decision making as to the adequate treatment of endoleaks. Irrespective of the types of stent graft and property of the material, five endoleak types are defined in the literature: leakage at the anchor sites (type I); leakage due to collateral arteries (type II); defective stent grafts (type III); leakage due to porosity of the graft material (type IV); and endotension (type V). The causes of endoleaks are discussed and treatment options are reviewed for the diverse pathologic findings.

Key words

Abdominal aortic aneurysm - endovascular treatment - endoleaks

Literatur

  • 1 Matsumura J S, Brewster D C, Makaroun M S. et al . A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurym.  J Vasc Surg. 2003;  37 262-271
    CrossrefPubMedGoogle Scholar
  • 2 Teufelsbauer H, Prusa A M, Wolff K. et al . Endovascular stent grafting versus open surgical operation in patients with infrarenal aortic aneurysms.  Circulation. 2002;  106 782-787
    CrossrefPubMedGoogle Scholar
  • 3 Laheij R JF, Buth J, Harris P L. et al . Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR).  British J Surg. 2000;  87 1666-1673
    CrossrefPubMedGoogle Scholar
  • 4 Sampram E S, Karafa M T, Mascha E J. et al . Nature, frequency, and predictors of secondary procedures after endovascular repair of abdominal aortic aneurysm.  J Vasc Surg. 2003;  37 930-937
    PubMedGoogle Scholar
  • 5 Pitton M B, Schweitzer H, Herber S. et al . Klinisch-radiologische Ergebnisse der endovaskulären Aneurysmatherapie im mittelfristigen Verlauf.  Fortschr Röntgenstr. 2003;  175 1392-1402
    PubMedGoogle Scholar
  • 6 Matsumura J, Moore W. Clinical consequences of periprosthetic leak after endovascular repair of abdominal aortic aneurysm.  J Vasc Surg. 1998;  27 606-613
    PubMedGoogle Scholar
  • 7 Chuter T AM, Risberg B, Hopkinson B R. et al . Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair.  J Vasc Surg. 1996;  24 655-666
    PubMedGoogle Scholar
  • 8 Coppi G, Moratto R, Silingardi R. et al . The italian trial of endovascular AAA exclusion using the Parodi endograft.  J Endovasc Surg. 1997;  4 299-306
    CrossrefPubMedGoogle Scholar
  • 9 Alimi Y S, Chakfe N, Rivoal E. et al . Rupture of an abdominal aortic aneurysm after endovascular graft placement and aneurysm size reduction.  J Vasc Surg. 1998;  28 178-183
    PubMedGoogle Scholar
  • 10 Hölzenbein T J, 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
    PubMedGoogle Scholar
  • 11 May J, White G H, Waugh R. et al . Rupture of abdominal aortic aneurysms: A concurrent comparison of outcome of those occuring after endoluminal repair versus those occuring de novo.  Eur J Vasc Endovasc Surg. 1999;  18 344-348
    CrossrefPubMedGoogle Scholar
  • 12 Veith F J, Baum R A, Ohki T. et al . Nature and significance of endoleaks and endotension: Summary of opinions expressed at an international conference.  J Vasc Surg. 2002;  35 1029-1035
    CrossrefPubMedGoogle Scholar
  • 13 Baum R A, Stavropoulos S W, RM. et al . Endoleaks after endovascular repair of abdominal aortic aneurysms.  J Vasc Interv Radiol. 2003;  14 1111-1117
    CrossrefPubMedGoogle Scholar
  • 14 Pitton M B, Schmenger P, Düber C. et al . Endovascular treatment of aortic aneurysms: Pressure transmission into experimental aneurysms with persisting endoleaks.  CVIR. 2003;  26 283-289
    CrossrefPubMedGoogle Scholar
  • 15 Wolf Y G, Tillich M, Lee W A. et al . Changes in aneurysm volume after endovascular repair of abdominal aortic aneurysm.  J Vasc Surg. 2002;  36 305-309
    PubMedGoogle Scholar
  • 16 Haulon S, Lions C, McFadden E P. et al . Prospective evaluation of magnetic resonance imaging after endovascular treatment of onfrarenal aortic aneurysms.  Eur J Vasc Endovasc Surg. 2001;  22 62-69
    CrossrefPubMedGoogle Scholar
  • 17 Cejna M, Loewe C, Schoder M. et al . MR angiography vs CT angiography in follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms.  Eur Radiol. 2002;  12 2443-2450
    PubMedGoogle Scholar
  • 18 Insko E K, Kulzer L M, Fairman R M. et al . MR imaging for the detection of endoleaks in recipients of abdominal aortic stent-grafts with low magnetic susceptibility.  Acad Radiol. 2003;  10 509-513
    CrossrefPubMedGoogle Scholar
  • 19 Lee J T, Aziz I N, Lee J T. et al . Volume regression of abdominal aortic aneurysms and its relation to successful endoluminal exclusion.  J Vasc Surg. 2003;  38 1254-1263
    PubMedGoogle Scholar
  • 20 Bertges D J, Chow K, Wyers M C. et al . Abdominal aortic aneurysm size regression after endovascular repair is endograft dependent.  J Vasc Surg. 2003;  37 716-723
    CrossrefPubMedGoogle Scholar
  • 21 Greenberg R K, Deaton D, Sullivan T. et al . Variable sac behavior after endovascular repair of abdominal aortic aneurysm: Analysis of core laboratory data.  J Vasc Surg. 2004;  39 95-101
    CrossrefPubMedGoogle Scholar
  • 22 Sternbergh W C, Conners M S, Tonnessen B H. et al . Aortic aneurysm sac shrinkage after endovascular repair is device-dependent: a comparison of Zenith and AneuRx endografts.  Ann Vasc Surg. 2003;  17 49-53
    CrossrefPubMedGoogle Scholar
  • 23 White G H, Yu W, May J. et al . Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: calssification, incidence, diagnosis, and management.  J Endovasc Surg. 1997;  4 152-168
    CrossrefPubMedGoogle Scholar
  • 24 White G H, May J, Waugh R C. et al . Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair.  J Endovasc Surg. 1998;  5 305-309
    CrossrefPubMedGoogle Scholar
  • 25 Gilling-Smith G, Brennan J, Harries P. et al . Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention.  J Endovasc Surg. 1999;  6 305-307
    CrossrefPubMedGoogle Scholar
  • 26 White G H, May J, Petrasek P. et al . Endotension: an explanation for continued AAA growth after successful endoluminal repair.  J Endivasc Surg. 1999;  6 308-315
    CrossrefPubMedGoogle Scholar
  • 27 Resch T, Malina M, Lindblad B. et al . The impact of stent design on proximal stent-graft fixation in the abdominal aorta: an experimental study.  Eur J Vasc Endovasc Surg. 2000;  20 190-195
    CrossrefPubMedGoogle Scholar
  • 28 Sternbergh W C, Money S R, Greenberg R K. et al . Influence of endograft oversizing on the device migration, endoleak, aneurysm shrinkage, and aortic neck dilataion: results from the Zenith multicenter trial.  J Vasc Surg. 2004;  39 20-26
    CrossrefPubMedGoogle Scholar
  • 29 Wolf Y G, Hill B B, Lee W A. et al . Eccentric stent graft compression: an indicator of insecure proximal fixation of aortic stent graft.  J Vasc Surg. 2001;  33 481-487
    PubMedGoogle Scholar
  • 30 Sternbergh W C, Carter G, York J W. et al . Aortic neck angulation predicts adverse outcome with endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2002;  35 482-486
    CrossrefPubMedGoogle Scholar
  • 31 Zarins C K, Bloch D A, Crabtree T. et al . Stent graft migration after endovascular aneurysm repair : Importance of proximal fixation.  J Vasc Surg. 2003;  38 1264-1272
    CrossrefPubMedGoogle Scholar
  • 32 Cao P, Verzini F, Parlani G. et al . Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta anerysm repair with self-expandable stent-grafts.  J Vasc Surg. 2003;  37 1200-1205
    PubMedGoogle Scholar
  • 33 Krajcar Z, Gupta K, Dougherty K G. Mechanical trauma as a cause of late compliacations: after AneuRx Stent Graft repair of abdominal aortic aneurysms.  Tex.Heart Inst J. 2003;  30 186-193
    PubMedGoogle Scholar
  • 34 Faries P L, Cadot H, Agrawal G. et al . Management of endoleak after endovascular aneurysm repair: Cuffs, coils, and conversion.  J Vasc Surg. 2003;  37 1155-1161
    CrossrefPubMedGoogle Scholar
  • 35 Pitton M B, Schmenger P, Düber C. et al . Endovaskuläre Aneurysmatherapie: Radiologische und makropathologische Befunde der endoluminalen Oberfläche bei modularen Stentprothesen.  Fortschr Röntgenstr. 2002;  174 579-587
    PubMedGoogle Scholar
  • 36 Tzortzis E, Hinchliffe R J, Hopkinson B R. Adjunctive precedures for the treatment of proximal type I endoleak: the role of peri-aortic ligatures and Palmaz stenting.  J Endovasc Ther. 2003;  10 233-239
    CrossrefPubMedGoogle Scholar
  • 37 Lipsitz E C, Ohki T, Veith F J. et al . Delayed open conversion following endovascular aortoiliac aneurysm repair: Partial (or complete) endograft preservation as a useful adjunct.  J Vasc Surg. 2003;  38 1191-1198
    PubMedGoogle Scholar
  • 38 Kirby L, Goodwin J. Treatment of a primary type IA endoleak with a liquid embolic system under conditions of aortic occlusion.  J Vasc Surg. 2003;  37 456-460
    PubMedGoogle Scholar
  • 39 Maldonado T S, Rosen R J, Rockman C B. et al . Initial successful management of type I endoleak after endovascular aneurysm repair with n-butyl-cyanoacrylate adhesive.  J Vasc Surg. 2003;  38 664-670
    CrossrefPubMedGoogle Scholar
  • 40 Fan C M, Rafferty E A, Geller S C. et al . Endovascular stent-graft in abdominal aortic aneurysms: the relationship between vessels that arise from the aneurysmal sac and early endoleak.  Radiology. 2001;  218 176-182
    PubMedGoogle Scholar
  • 41 Back M R, Bowser A N, Johnson B L. et al . Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair.  Ann Vasc Surg. 2003;  17 27-34
    CrossrefPubMedGoogle Scholar
  • 42 Matsumura J S, Brewster D C, Makaroun M S. et al . A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurym.  J Vasc Surg. 2003;  37 262-271
    CrossrefPubMedGoogle Scholar
  • 43 Arko F R, Rubin G D, Johnson B L. et al . Type-II endoleaks following endovascular AAA repair: preoperative predictors and long-term effects.  J Endovasc Ther. 2001;  8 503-510
    CrossrefPubMedGoogle Scholar
  • 44 Farner M C, Carpenter J P, Baum R A. et al . Early changes in abdominal aortic aneurysm diameter after endovascular repair.  J Vasc Intervent Radiol. 2003;  14 205-210
    PubMedGoogle Scholar
  • 45 Hinchliffe R J, Singh-Ranger R, Davidson I R. et al . Rupture of an abdominal aortic aneurysm secondary to type II endoleak.  Eur J Vasc Endovasc Surg. 2001;  22 563-565
    CrossrefPubMedGoogle Scholar
  • 46 Pitton M B, Schmenger P, Düber C. et al . Endovascular treatment of aortic aneurysms: Pressure transmission into experimental aneurysms with persisting endoleaks.  CVIR. 2003;  26 283-289
    CrossrefPubMedGoogle Scholar
  • 47 Fairman R M, Carpenter J P, Baum R A. et al . Potential impact of therapeutic warafin treatment on type II endoleaks and sac shrinkage rates on midterm follow-up examination.  J Vasc Surg. 2002;  35 679-685
    PubMedGoogle Scholar
  • 48 Maldonado T S, Gagne P J. Controversies in the management of type II „branch” endoleaks following endovacular abdominal aortic aneurym repair.  Vasc Endovascular Surg. 2003;  31 1-12
    PubMedGoogle Scholar
  • 49 Bonvini R, Alerci M, Antonucci F. et al . Preoperative embolization of collateral side branches: a valid means to reduce type II endoleaks after endovascular AAA repair.  J Endovasc Ther. 2003;  10 227-232
    CrossrefPubMedGoogle Scholar
  • 50 Kasirajan K, Matteson B, Marek J M. et al . Technique and results of transfemoral superselective coil embolisation of type II lumbar endoleak.  J Vasc Surg. 2003;  38 61-66
    PubMedGoogle Scholar
  • 51 Hansen C J, Kim B, Aziz I. et al . Late-onset type-II endoleaks and the incidence of secondary intervention.  Ann Vasc Surg. 2004 (epub); 
    PubMedGoogle Scholar
  • 52 Baum R A, Carpenter J P, Golden M A. et al . Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: Comparison of transarterial and translumbar techniques.  J Vasc Surg. 2002;  35 23-29
    CrossrefPubMedGoogle Scholar
  • 53 Haulon S, Tyazi A, Willoteaux S. et al . Embolization of type II endoleaks after aortic stent-graft implantation: technique and immediate results.  J Vasc Surg. 2001;  34 600-605
    PubMedGoogle Scholar
  • 54 Gambaro E, Abou-Zamzam A M Jr, Teruya T H. et al . Ischemic colitis following translumbar thrombin injection for treatment of endoleak.  Ann Vasc Surg. 2004;  12 epub
    PubMedGoogle Scholar
  • 55 Ellis P K, Kennedy P T, Collins A J. et al . The use of thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm.  CVIR. 2003;  21 epub
    PubMedGoogle Scholar
  • 56 Stavropoulos S W, Carpenter J P, Fairman R M. et al . Inferior vena cava traversal for translumbar endoleak embolization after endovascular abdominal aortic aneurysm repair.  J Vasc Interv Radiol. 2003;  14 (9 Pt 1) 1191-1194
    CrossrefPubMedGoogle Scholar
  • 57 van den Berg J C, Nolthenius R PT, Casparie J WBM. et al . CT-guided thrombin injection into aneurysm sac in a patient with endoleak after endovascular abdominal aortic aneurysm repair.  Am J Roentgenol. 2000;  175 1649-1651
    PubMedGoogle Scholar
  • 58 Wisselink W, Cuesta M A, Berends F J. et al . Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair.  J Vasc Surg. 2000;  31 1240-1244
    PubMedGoogle Scholar
  • 59 Gould D A, McWilliams R, Edwards R D. et al . Aortic side branch embolization before endovascular aneurysm repair: Incidence of Type II Endoleaks.  JVIR. 2001;  12 337-341
    CrossrefPubMedGoogle Scholar
  • 60 Solis M, Ayerdi J, Babcock G A. et al . Mechanism of failure in the treatment of type II endoleaks with percutaneous coil embolization.  J Vasc Surg. 2002;  36 485-491
    CrossrefPubMedGoogle Scholar
  • 61 Teruya T H, Ayerdi J, Solis M M. et al . Treatment of type III endoleak with an aortouniiliac stent graft.  Ann Vasc Surg. 2003;  17 123-128
    CrossrefPubMedGoogle Scholar
  • 62 Teutelink A, van der Laan M J, Milner R. et al . Fabric tears as a new cuase of type III endoleak with Ancur endograft.  J Vasc Surg. 2003;  38 1449
    PubMedGoogle Scholar
  • 63 Lee W A, Rubin G D, Johnson B L. et al . „Pseudoendoleak” - residual intrasaccular contrast after endovascular stent-graft repair.  J Endovasc Ther. 2002;  9 119-123
    CrossrefPubMedGoogle Scholar
  • 64 Meier G H, Parker F M, Godziachvili V. et al . Endotension after endovascular aneurysm repair: the Ancure experience.  J Vasc Surg. 2001;  34 421-426
    CrossrefPubMedGoogle Scholar
  • 65 Parodi J C, Berguer R, Ferreira L M. et al . Intra-aneurysmal pressure after incomplete endovascular exclusion.  J Vasc Surg. 2001;  34 909-914
    PubMedGoogle Scholar
  • 66 Chuter T A. Stent-graft design: the good, the bad and the ugly.  Cardiovasc Surg. 2002;  10 7-13
    CrossrefPubMedGoogle Scholar
  • 67 Ouriel K. Image in clinical medicine: Abdominal aortic aneuryms.  N Engl J Med. 2002;  346 1467
    PubMedGoogle Scholar
  • 68 Lorelli D R, Jean-Claude J M, Fox C J. et al . Response of plasma matrix metalloproteinase-9 to conventional abdominal aortic aneurysm repair or endovascular exclusion: implications for endoleak.  J Vasc Surg. 2002;  35 916-922
    PubMedGoogle Scholar
  • 69 Lin P H, Bush R L, Katzman J B. et al . Delayed aortic aneurysm enlargement due to endotension after endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2003;  38 840-842
    PubMedGoogle Scholar
  • 70 Lookstein R A, Goldman J, Pukin L. et al . Time-resolved magnetic resonance angiography as a noninvasive method to characterize endoleaks: initial results compared with conventional angiography.  J Vasc Surg. 2004;  39 27-33
    CrossrefPubMedGoogle Scholar
  • 71 Hilfiker P R, Quick H H, Pfammatter T. et al . Three-dimensional MR angiography of a nitinol-based abdominal aortic stent graft: assessment of heating and imaging characterisitcs.  Eur Radiol. 1999;  9 1775-1780
    CrossrefPubMedGoogle Scholar

PD Dr. Michael B. Pitton

Klinik für Radiologie, Universitätskliniken

Langenbeckstraße 1

55101 Mainz

Phone: ++ 49/61 31/17 20 19

Fax: ++ 49/61 31/17 66 33

Email: pitton@radiologie.klinik.uni-mainz.de

      >