Intra-Sac Pressure Measurement of Abdominal Aortic Aneurysm to Reveal The Characters of All Types of Endoleak_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHI Yun , FU Weiguo.

Division of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China;

Corresponding author：

Keywords：

Abdominal aortic aneurysm; Endoleak; Pressure transducer; Intra-sac pressure; Systemic pressure

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Objective　To review and compare the literatures on studying endoleak via intra-sac pressure (Psac) measurement in order to reveal the characters of all types of endoleak. Methods　Measured the intra-sac pressure with miscellaneous pressure transducers in vitro and in vivo endoleak models or patients afflicted with endoleak. Compared the difference of Psac among no endoleak and all types of endoleak. Results　Psac＞0 but was obviously lower than Psys in no endoleak. Psac approached Psys in type Ⅰ and type Ⅳ endoleaks. Some researches showed that Psac in type Ⅱ endoleak was higher than that in no endoleak and even approached Psys, however the other researches showed that Psac in type Ⅱ endoleak was lower than that in no endoleak. Conclusion　Postoperative Psac dropping greatly eliminated the risk of aneurysm rupture, which symbolized the success of endovascular therapy. Even if the type Ⅰ endoleak of small size might lead to obvious elevation of Psac, which necessitates management. The impairment and management tactics of type Ⅱ endoleak remained equivocal, which required further study.

Citation： SHI Yun,FU Weiguo.. Intra-Sac Pressure Measurement of Abdominal Aortic Aneurysm to Reveal The Characters of All Types of Endoleak. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2006, 13(6): 671-675. doi: Copy

1.	Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms [J]. Ann Vasc Surg， 1991; 5(6)∶491.
2.	White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management [J]. J Endovasc Surg， 1997; 4(2)∶152.
3.	Gilling-Smith G, Brennan J, Harris P, et al. Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention [J]. J Endovasc Surg， 1999; 6(4)∶305.
4.	White GH, May J, Petrasek P, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair [J]. J Endovasc Surg， 1999; 6(4)∶308.
5.	Schurink GW, Aarts NJ, Wilde J， et al. Endoleakage after st-ent-graft treatment of abdominal aneurysm: implications on pressure and imaging——an in vitro study [J]. J Vasc Surg， 1998; 28(2)∶234.
6.	Chong CK, How TV, Gilling-Smith GL, et al. Modeling endoleaks and collateral reperfusion following endovascular AAA exclusion [J]. J Endovasc Ther， 2003; 10(3)∶424.
7.	Sanchez LA, Faries PL, Marin ML, et al. Chronic intraaneurysmal pressure measurement: an experimental method for evaluating the effectiveness of endovascular aortic aneurysm exclusion [J]. J Vasc Surg， 1997; 26(2)∶222.
8.	Diaz S, Uzieblo MR, Desai KM, et al.Type Ⅱ endoleak in porcine model of abdominal aortic aneurysm [J]. J Vasc Surg， 2004; 40(2)∶339.
9.	Dayal R, Mousa A, Bernheim J, et al. Characterization of retrograde collateral (type Ⅱ) endoleak using a new canine model [J]. J Vasc Surg， 2004; 40(5)∶985.
10.	Criado E, Marston WA, Woosley JT, et al. An aortic aneurysm model for the evaluation of endovascular exclusion prostheses [J]. J Vasc Surg， 1995; 22(3)∶306.
11.	Chuter T, Ivancev K, Malina M, et al. Aneurysm pressure following endovascular exclusion [J]. Eur J Vasc Endovasc Surg， 1997; 13(1)∶85.
12.	Treharne GD, Loftus IM, Thompson MM, et al. Quality control during endovascular aneurysm repair: monitoring aneurysmal sac pressure and superficial femoral artery flow velocity [J]. J Endovasc Surg， 1999; 6(3)∶239.
13.	Baum RA, Carpenter JP, Tuite CM, et al. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms [J]. Radiology， 2000; 215(2)∶409.
14.	Sonesson B, Dias N, Malina M, et al. Intra-aneurysm pressure measurements in successfully excluded abdominal aortic aneurysm after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶733.
15.	Ellozy SH, Carroccio A, Lookstein RA, et al. First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms [J]. J Vasc Surg， 2004; 40(3)∶405.
16.	Parodi JC, Berguer R, Ferreira LM, et al.Intra-aneurysmal pressure after incomplete endovascular exclusion [J]. J Vasc Surg， 2001; 34(5)∶909.
17.	Chaudhuri A, Ansdell LE, Grass AJ, et al. Intrasac pressure waveforms after endovascular aneurysm repair (EVAR) are a reliable marker of type Ⅰ endoleaks, but not type Ⅱ or combined types: an experimental study [J]. Eur J Vasc Endovasc Surg， 2004; 28(4)∶373.
18.	Xenos ES, Stevens SL, Freeman MB, et al. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types Ⅰ and Ⅱ [J].J Endovasc Ther， 2003; 10(3)∶516.
19.	Mehta M, Veith FJ, Ohki T, et al. Significance of endotension, endoleak, and aneurysm pulsatility after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶842.
20.	Szilagyi DE, Elliott JP, Smith RF. Clinical fate of the patient with asymptomatic abdominal aortic aneurysm and unfit for surgical treatment [J]. Arch Surg， 1972; 104(4)∶600.
21.	Pacanowski JP, Stevens SL, Freeman MB, et al. Endotension distribution and the role of thrombus following endovascular AAA exclusion [J]. J Endovasc Ther， 2002; 9(5)∶639.
22.	Schurink GW, van Baalen JM, Visser MJ, et al.Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall [J]. J Vasc Surg， 2000; 31(3)∶501.
23.	Vallabhaneni SR, Gilling-Smith GL, Brennan JA, et al. Can intrasac pressure monitoring reliably predict failure of endovascular aneurysm repair? [J]. J Endovasc Ther， 2003; 10(3)∶524.
24.	Englund R, Lalak N, Jacques T, et al. Sigmoid and gastric tonometry during infrarenal aortic aneurysm repair [J]. Aust N Z J Surg， 1996; 66(2)∶88.
25.	Shigematsu H, Nunokawa M, Hatakeyama T, et al. Inferior mesenteric and hypogastric artery reconstruction to prevent colonic ischaemia following abdominal aortic aneurysmectomy [J]. Cardiovasc Surg， 1993; 1(1)∶13.
26.	Resch T, Ivancev K, Lindh M, et al. Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter [J]. J Vasc Surg， 1998; 28(2)∶242.
27.	Liewald F, Ermis C, Gorich J, et al. Influence of treatment of type Ⅱ leaks on the aneurysm surface area [J]. Eur J Vasc Endovasc Surg， 2001; 21(4)∶339.
28.	Malina M, Ivancev K, Chuter TA, et al. Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion [J]. J Endovasc Surg， 1997； 4(1)∶23.
29.	Gorich J, Rilinger N, Sokiranski R, et al. Embolization of type Ⅱ endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach [J]. J Endovasc Ther， 2000; 7(4)∶297.
30.	Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases [J]. J Vasc Surg， 2000; 31(3)∶599.
31.	Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial [J]. J Vasc Surg， 2000; 32(1)∶90.
32.	van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type Ⅱ endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up [J].Eur J Vasc Endovasc Surg， 2004; 27(2)∶128.

1. 　Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms [J]. Ann Vasc Surg， 1991; 5(6)∶491.
2. 　White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management [J]. J Endovasc Surg， 1997; 4(2)∶152.
3. 　Gilling-Smith G, Brennan J, Harris P, et al. Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention [J]. J Endovasc Surg， 1999; 6(4)∶305.
4. 　White GH, May J, Petrasek P, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair [J]. J Endovasc Surg， 1999; 6(4)∶308.
5. 　Schurink GW, Aarts NJ, Wilde J， et al. Endoleakage after st-ent-graft treatment of abdominal aneurysm: implications on pressure and imaging——an in vitro study [J]. J Vasc Surg， 1998; 28(2)∶234.
6. 　Chong CK, How TV, Gilling-Smith GL, et al. Modeling endoleaks and collateral reperfusion following endovascular AAA exclusion [J]. J Endovasc Ther， 2003; 10(3)∶424.
7. 　Sanchez LA, Faries PL, Marin ML, et al. Chronic intraaneurysmal pressure measurement: an experimental method for evaluating the effectiveness of endovascular aortic aneurysm exclusion [J]. J Vasc Surg， 1997; 26(2)∶222.
8. 　Diaz S, Uzieblo MR, Desai KM, et al.Type Ⅱ endoleak in porcine model of abdominal aortic aneurysm [J]. J Vasc Surg， 2004; 40(2)∶339.
9. 　Dayal R, Mousa A, Bernheim J, et al. Characterization of retrograde collateral (type Ⅱ) endoleak using a new canine model [J]. J Vasc Surg， 2004; 40(5)∶985.
10. 　Criado E, Marston WA, Woosley JT, et al. An aortic aneurysm model for the evaluation of endovascular exclusion prostheses [J]. J Vasc Surg， 1995; 22(3)∶306.
11. 　Chuter T, Ivancev K, Malina M, et al. Aneurysm pressure following endovascular exclusion [J]. Eur J Vasc Endovasc Surg， 1997; 13(1)∶85.
12. 　Treharne GD, Loftus IM, Thompson MM, et al. Quality control during endovascular aneurysm repair: monitoring aneurysmal sac pressure and superficial femoral artery flow velocity [J]. J Endovasc Surg， 1999; 6(3)∶239.
13. 　Baum RA, Carpenter JP, Tuite CM, et al. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms [J]. Radiology， 2000; 215(2)∶409.
14. 　Sonesson B, Dias N, Malina M, et al. Intra-aneurysm pressure measurements in successfully excluded abdominal aortic aneurysm after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶733.
15. 　Ellozy SH, Carroccio A, Lookstein RA, et al. First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms [J]. J Vasc Surg， 2004; 40(3)∶405.
16. 　Parodi JC, Berguer R, Ferreira LM, et al.Intra-aneurysmal pressure after incomplete endovascular exclusion [J]. J Vasc Surg， 2001; 34(5)∶909.
17. 　Chaudhuri A, Ansdell LE, Grass AJ, et al. Intrasac pressure waveforms after endovascular aneurysm repair (EVAR) are a reliable marker of type Ⅰ endoleaks, but not type Ⅱ or combined types: an experimental study [J]. Eur J Vasc Endovasc Surg， 2004; 28(4)∶373.
18. 　Xenos ES, Stevens SL, Freeman MB, et al. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types Ⅰ and Ⅱ [J].J Endovasc Ther， 2003; 10(3)∶516.
19. 　Mehta M, Veith FJ, Ohki T, et al. Significance of endotension, endoleak, and aneurysm pulsatility after endovascular repair [J]. J Vasc Surg， 2003; 37(4)∶842.
20. 　Szilagyi DE, Elliott JP, Smith RF. Clinical fate of the patient with asymptomatic abdominal aortic aneurysm and unfit for surgical treatment [J]. Arch Surg， 1972; 104(4)∶600.
21. 　Pacanowski JP, Stevens SL, Freeman MB, et al. Endotension distribution and the role of thrombus following endovascular AAA exclusion [J]. J Endovasc Ther， 2002; 9(5)∶639.
22. 　Schurink GW, van Baalen JM, Visser MJ, et al.Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall [J]. J Vasc Surg， 2000; 31(3)∶501.
23. 　Vallabhaneni SR, Gilling-Smith GL, Brennan JA, et al. Can intrasac pressure monitoring reliably predict failure of endovascular aneurysm repair? [J]. J Endovasc Ther， 2003; 10(3)∶524.
24. 　Englund R, Lalak N, Jacques T, et al. Sigmoid and gastric tonometry during infrarenal aortic aneurysm repair [J]. Aust N Z J Surg， 1996; 66(2)∶88.
25. 　Shigematsu H, Nunokawa M, Hatakeyama T, et al. Inferior mesenteric and hypogastric artery reconstruction to prevent colonic ischaemia following abdominal aortic aneurysmectomy [J]. Cardiovasc Surg， 1993; 1(1)∶13.
26. 　Resch T, Ivancev K, Lindh M, et al. Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter [J]. J Vasc Surg， 1998; 28(2)∶242.
27. 　Liewald F, Ermis C, Gorich J, et al. Influence of treatment of type Ⅱ leaks on the aneurysm surface area [J]. Eur J Vasc Endovasc Surg， 2001; 21(4)∶339.
28. 　Malina M, Ivancev K, Chuter TA, et al. Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion [J]. J Endovasc Surg， 1997； 4(1)∶23.
29. 　 Gorich J, Rilinger N, Sokiranski R, et al. Embolization of type Ⅱ endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach [J]. J Endovasc Ther， 2000; 7(4)∶297.
30. 　Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases [J]. J Vasc Surg， 2000; 31(3)∶599.
31. 　Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial [J]. J Vasc Surg， 2000; 32(1)∶90.
32. 　van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type Ⅱ endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up [J].Eur J Vasc Endovasc Surg， 2004; 27(2)∶128.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Intra-Sac Pressure Measurement of Abdominal Aortic Aneurysm to Reveal The Characters of All Types of Endoleak

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