Abstract
BackgroundTo evaluate residual endoleak and thrombus organisation with shear wave imaging (SWI) after endoleak embolisation through an animal study.MethodsThis prospective experimental study involved eight dogs with creation of 16 iliac aneurysms and type I endoleak after endovascular aneurysm repair (EVAR). Embolisation agents were injected into the sac to seal endoleak. SWI and colour flow Doppler ultrasound (DUS) were performed at implantation, one week, and one and three months after implantation; for three dogs, SWI and DUS were also performed six months after implantation. Digital subtraction angiography and contrast-enhanced computed tomography were performed at sacrifice. Macroscopic and histopathological analyses were processed to identify regions of interest (ROIs) for endoleak, fresh thrombus, organised thrombus and embolisation agent, where SWI elasticity moduli were compared.ResultsAt sacrifice, nine aneurysms had residual endoleak, while seven were sealed. Ten had a fresh and 15 had an organised thrombus. SWI was able to detect all endoleaks, including two cases undetected with DUS. Elasticity moduli of 0.2 kPa ± 0.1 kPa (mean ± SD), 9.5 kPa ± 3.3 kPa, 48.1 kPa ± 21.3 kPa and 44.9 kPa ± 23.7 kPa were found in the ROIs positioned in endoleaks, fresh thrombi, organised thrombi and embolisation agent, respectively. Elasticity values of endoleak and fresh thrombus were lower than those of organised thrombi and embolisation agent (p < 0.001). Stiffness of fresh thrombus at one week (8.7 kPa ± 3.6 kPa) increased at three months (30.2 kPa ± 13.8 kPa), indicating thrombus maturation (p < 0.001).ConclusionsIn a dog model of iliac EVAR, SWI was able to identify endoleak, thrombus maturation and embolising agents after endoleak embolisation.
Highlights
To evaluate residual endoleak and thrombus organisation with shear wave imaging (SWI) after endoleak embolisation through an animal study
Endoleak is the main complication of endovascular aneurysm repair (EVAR) requiring lifelong follow-up with computed tomography (CT) or Doppler ultrasound (DUS) [1]
DUS is recommended after one-year CT follow-up, if there is no evidence of endoleak [4]
Summary
To evaluate residual endoleak and thrombus organisation with shear wave imaging (SWI) after endoleak embolisation through an animal study. Follow-up with CT leads to the potential nephrotoxicity of iodined contrast and a not negligible cumulative exposure to ionising radiation, with an attributable cancer risk estimated to be 0.65% for a 55-year-old patient [2, 3]. In this setting, DUS is recommended after one-year CT follow-up, if there is no evidence of endoleak [4]. DUS sensitivity is limited in particular for the detection of type II endoleak [5]. Magnetic resonance imaging (MRI) has shown that patients with an endoleak or endotension have areas of non-organised thrombi [6]
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