Characterization of endoleaks by dynamic computed tomographic angiography

Current imaging modalities may not be able to detect endoleaks, differentiate between type II and type III, or localize inflow and outflow sources. We describe a new technique that can characterize endoleaks to guide secondary intervention. One hundred four patients with Zenith (Cook, Inc.) endograft repair of abdominal aortic aneurysms (AAAs) were monitored by serial computed tomographic angiography (CTA). Endoleaks were evaluated with a dynamic CTA using a stationary table position, 24-mm beam collimation, and continuous scanning over 30 to 40 seconds to create a cine. Twelve patients (12%) had endoleaks that persisted or appeared more than 30 days post-deployment. Five patients in whom the standard CT surveillance protocol could not differentiate type II versus type III endoleaks underwent dynamic CTA. This technique accurately characterized the endoleaks and localized inflow and outflow branches to guide the subsequent successful secondary interventions. Dynamic CTA is a useful technique to evaluate endoleaks for characterization and precise localization to guide secondary interventional therapy.