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Images in Anesthesia: Echo contrast as an adjunct to intraoperative angiography in the detection of endoleaks

Peter Lougheed Centre, University of Calgary, Calgary, Canada E-mail: gary.dobson{at}calgaryhealthregion.ca

ENDOVASCULAR repair is becoming the preferred management of traumatic disruption, dissection and aneurysmal disease of the thoracic aorta. Identifying and managing endoleaks is critical for the technical success of these reconstructions. Intraoperative transesophageal echocardiographic (TEE) examination of the endovascular stent provides a sensitive and safe means of detecting endoleaks, with a published algorithm out-lining a systematic approach.¹

Colour Doppler interrogation of the stent is used to identify possible endoleaks. Quantification of the velocity within the endoleak using pulse wave Doppler helps to discriminate true leaks from "porosity", with a minimum peak velocity of 50 cm·sec^–1 arise when there is an obvious endoleak demonstrated with TEE that cannot be seen on angiography.

In this case, the post-traumatic disruption of the descending aorta was repaired with an endovascular stent. Following stent deployment there was no demonstrable endoleak on angiography (Figure 1) but a significant leak was detected using TEE (Figure 2; colour images and video imaging are available as Additional Material at: www.cja-jca.org). An infusion of echo-contrast (definity) resulted in opacification of the pseudo-aneurysm (Figure 2). The appearance of echo contrast outside the lumen of the endovascular stent confirmed the presence of a true endoleak² that required further intervention. Balloon inflation at the site of the endoleak resulted in a complete seal.

View larger version (101K): [in this window] [in a new window]   FIGURE 1 A) Angiogram demonstrating pseudo-aneurysm; B) Angiogram following endograft deployment, with no evidence of an endoleak.

View larger version (123K): [in this window] [in a new window]   FIGURE 2 A) Colour Doppler imaging of the endograft demonstrating an endoleak (arrow); B) Pulse wave Doppler of endoleak; C) Echo contrast opacifying the lumen of pseudo-aneurysm confirming endoleak. Colour images are available as Additional Material at: www:cja-jca.org.

	Footnotes

 
Accepted for publication February 2, 2006.

	References

TOP References

 
1 Rocchi G, Lofiego C, Biagini E, et al. Transesophageal echocardiography-guided algorithm for stent-graft implantation in aortic dissection. J Vasc Surg 2004; 40: 880–5.[Medline]

2 Heilberger P, Schunn C, Ritter W, Weber S, Raithel D. Postoperative color flow duplex scanning in aortic endografting. J Endovasc Surg 1997; 4: 262–71.[Medline]

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This Article Full Text (PDF) Additional Material Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dobson, G. Articles by Moore, R. Search for Related Content PubMed PubMed Citation Articles by Dobson, G. Articles by Moore, R.