Use of cine magnetic resonance angiography in quantifying aneurysm pulsatility associated with endoleak

Peter L. Faries, Gautam Agarwal, Robert Lookstein, Joshua W. Bernheim, Neal S. Cayne, Hadley Cadot, Jeffery Goldman, K. Craig Kent, Larry H. Hollier, Michael L. Marin

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective: Persistent aneurysm perfusion or endoleak is associated with pulsatility of abdominal aortic aneurysm (AAA) after endovascular repair. However, the resultant pulsatile change in aneurysm diameter may be difficult to quantify, and therefore its significance is unknown. In this study cine magnetic resonance angiography (MRA) was used to quantify aneurysm wall motion during the cardiac cycle and to correlate it with the presence and type of endoleak. Methods: Cine MRA was performed in 16 patients undergoing endovascular repair of AAA. A 1.5 T magnet and post-processing with GEMS 4.0 Fiesta computerized video image analysis software were used to calculate maximum aortic diameter during systole and diastole. Changes in aortic diameter were determined from these measurements. Cine MRA was performed on aneurysms before treatment and in patients with and without endoleak after endovascular repair. Type of endoleak was confirmed at angiography in all cases. Four patients had antegrade (type I) endoleak, and eight patients had retrograde (type II) endoleak; no endoleak was present in four patients. Endovascular grafts with stent support throughout the entire length of the graft (Talent) were used in all cases (14 bifurcated grafts, 2 tube grafts). Results: Cine MRA demonstrated significantly greater wall motion and resultant change in aneurysm diameter in patients with type I endoleak compared with patients without endoleak (type I, 2.14 ± 1.28 mm vs no endoleak, 0.12 ± 0.09 mm, P = .001). Change in aneurysm diameter in patients with type II endoleak was not significantly greater than in patients with no endoleak (type II, 0.26 ± 0.21 mm vs no endoleak, 0.12 ± 0.09 mm, P = NS). Untreated aneurysms demonstrated the greatest change in diameter during the cardiac cycle (3.51 ± 0.79 mm). Conclusion: Cine MRA may be used to accurately quantify AAA wall motion before and after endovascular stent-graft treatment. The extent of change in diameter corresponds to the type of endoleak, with antegrade (type I) endoleak generating greater pulsatile change in diameter than retrograde-collateral (type II) endoleak or no endoleak. Cine MRA may provide a noninvasive means of assessing the success of endovascular treatment of AAA. Further studies will be necessary to confirm the utility and efficacy of cine MRA in postoperative assessment of endovascular aneurysm repair.

Original languageEnglish (US)
Pages (from-to)652-656
Number of pages5
JournalJournal of Vascular Surgery
Volume38
Issue number4
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

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Endoleak
Magnetic Resonance Angiography
Aneurysm
Abdominal Aortic Aneurysm
Transplants
Stents
Aptitude
Diastole
Magnets
Systole

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Use of cine magnetic resonance angiography in quantifying aneurysm pulsatility associated with endoleak. / Faries, Peter L.; Agarwal, Gautam; Lookstein, Robert; Bernheim, Joshua W.; Cayne, Neal S.; Cadot, Hadley; Goldman, Jeffery; Kent, K. Craig; Hollier, Larry H.; Marin, Michael L.

In: Journal of Vascular Surgery, Vol. 38, No. 4, 01.01.2003, p. 652-656.

Research output: Contribution to journalArticle

Faries, PL, Agarwal, G, Lookstein, R, Bernheim, JW, Cayne, NS, Cadot, H, Goldman, J, Kent, KC, Hollier, LH & Marin, ML 2003, 'Use of cine magnetic resonance angiography in quantifying aneurysm pulsatility associated with endoleak', Journal of Vascular Surgery, vol. 38, no. 4, pp. 652-656. https://doi.org/10.1016/S0741-5214(03)00944-3
Faries, Peter L. ; Agarwal, Gautam ; Lookstein, Robert ; Bernheim, Joshua W. ; Cayne, Neal S. ; Cadot, Hadley ; Goldman, Jeffery ; Kent, K. Craig ; Hollier, Larry H. ; Marin, Michael L. / Use of cine magnetic resonance angiography in quantifying aneurysm pulsatility associated with endoleak. In: Journal of Vascular Surgery. 2003 ; Vol. 38, No. 4. pp. 652-656.
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AU - Faries, Peter L.

AU - Agarwal, Gautam

AU - Lookstein, Robert

AU - Bernheim, Joshua W.

AU - Cayne, Neal S.

AU - Cadot, Hadley

AU - Goldman, Jeffery

AU - Kent, K. Craig

AU - Hollier, Larry H.

AU - Marin, Michael L.

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N2 - Objective: Persistent aneurysm perfusion or endoleak is associated with pulsatility of abdominal aortic aneurysm (AAA) after endovascular repair. However, the resultant pulsatile change in aneurysm diameter may be difficult to quantify, and therefore its significance is unknown. In this study cine magnetic resonance angiography (MRA) was used to quantify aneurysm wall motion during the cardiac cycle and to correlate it with the presence and type of endoleak. Methods: Cine MRA was performed in 16 patients undergoing endovascular repair of AAA. A 1.5 T magnet and post-processing with GEMS 4.0 Fiesta computerized video image analysis software were used to calculate maximum aortic diameter during systole and diastole. Changes in aortic diameter were determined from these measurements. Cine MRA was performed on aneurysms before treatment and in patients with and without endoleak after endovascular repair. Type of endoleak was confirmed at angiography in all cases. Four patients had antegrade (type I) endoleak, and eight patients had retrograde (type II) endoleak; no endoleak was present in four patients. Endovascular grafts with stent support throughout the entire length of the graft (Talent) were used in all cases (14 bifurcated grafts, 2 tube grafts). Results: Cine MRA demonstrated significantly greater wall motion and resultant change in aneurysm diameter in patients with type I endoleak compared with patients without endoleak (type I, 2.14 ± 1.28 mm vs no endoleak, 0.12 ± 0.09 mm, P = .001). Change in aneurysm diameter in patients with type II endoleak was not significantly greater than in patients with no endoleak (type II, 0.26 ± 0.21 mm vs no endoleak, 0.12 ± 0.09 mm, P = NS). Untreated aneurysms demonstrated the greatest change in diameter during the cardiac cycle (3.51 ± 0.79 mm). Conclusion: Cine MRA may be used to accurately quantify AAA wall motion before and after endovascular stent-graft treatment. The extent of change in diameter corresponds to the type of endoleak, with antegrade (type I) endoleak generating greater pulsatile change in diameter than retrograde-collateral (type II) endoleak or no endoleak. Cine MRA may provide a noninvasive means of assessing the success of endovascular treatment of AAA. Further studies will be necessary to confirm the utility and efficacy of cine MRA in postoperative assessment of endovascular aneurysm repair.

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