Presentation
Persistent ? Type 1 endoleak (discovered under US), planning for intervention
Patient Data
Dynamic CTA demonstrates a type Ia endoleak originating from the superior border of the graft. The leak courses through the aneurysm thrombus before terminating at the IMA ostia.
Also demonstrated clearly are bilateral lower pole renal infarcts.
Case Discussion
EVAR graft leaks are a potentially serious complication of EVAR. Detection and characterization of endoleaks are important to ensure the optimal management plan is carried out.
Dynamic CTA has been found 1 to be a suitable and lower-dose alternative to traditional angiography in the detection of endoleaks.
This case clearly demonstrates the nature of the type 1a endoleak previously detected on the vascular US. The leak originates at the superior portion of the stent and courses through the intramural thrombus before terminating at the IMA ostia, supplying it with blood. The dynamic aspect to this scan helps confirm that the leak is indeed a type Ia and not an IMA-based type IIa leak as contrast flows proximally to distal.
This exam was performed using the following protocol 1:
- non-contrast abdomen
- dynamic CTA of the stent
- test bolus of 10ml:15ml contrast:saline at 5.0ml/sec
- CTA of 100ml:50mL contrast:saline at 5.0ml/sec
- delayed abdomen
The total dose of this protocol is approx 15-20mSv depending on patient size.
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