Type II lumbar endoleaks: Hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular.

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Type II lumbar endoleaks: Hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular aneurysm repair Irene Bargellini, MD, Vinicio Napoli, MD, Pasquale Petruzzi, MD, Roberto Cioni, MD, Claudio Vignali, MD, Savino G. Sardella, MD, Mauro Ferrari, MD, Carlo Bartolozzi, MD Journal of Vascular Surgery Volume 41, Issue 1, Pages 10-18 (January 2005) DOI: 10.1016/j.jvs.2004.10.037 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 Patient 1, 78-year-old man with hyperdynamic endoleak. CTA shows a decrease in AAA volume at 20-month follow-up (B) compared to the 12-month follow-up control (A), despite the evidence of a type II endoleak visualized on the axial venous scans (C, arrow) fed by lumbar arteries (D, arrow). CUS shows the posterior endoleak (arrows) characterized by the wash-in at 40 seconds (E), progressive cavity filling (F), and washout at 360 seconds; the contrast material is no longer appreciated almost 10 minutes after contrast material administration. Arrowheads indicate the time (minutes and seconds) after injection of contrast material. At the top left corner, main parameters of CUS are indicated: mechanical index (MI) and derated pressure (DP). Journal of Vascular Surgery 2005 41, 10-18DOI: (10.1016/j.jvs.2004.10.037) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 Patient 14, 52-year-old man with hypodynamic endoleak. Compared to the 1-month CT control (A), the 12-month follow-up AAA volume shows a significant increase (B). However, no endoleak could be demonstrated at CTA. CUS shows the absence of enhancement in the first minute scan after contrast material injection (C); a posterior enhancement is appreciated more than 2 minutes after injection of contrast material (D, arrow), persisting for almost 10 minutes (E, arrow). Arrowheads indicate the time (minutes and seconds) after injection of contrast material. At the top left corner, main parameters of CUS are indicated: mechanical index (MI) and derated pressure (DP). Journal of Vascular Surgery 2005 41, 10-18DOI: (10.1016/j.jvs.2004.10.037) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions