ABSTRACT
PURPOSE: To determine the correlation of maximal diameter measurements with volumetric evaluation of size after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) using computed tomography angiography (CTA) and to survey its applicability for clinical follow-up. MATERIALS AND METHODS: 73 consecutive patients (2 females, 71 males; age 38-84 years; mean age, 69.1 ± 8 years) with AAA were treated with percutaneous EVAR in a single institution. For follow-up, CTA was performed periodically after EVAR. Images were evaluated for maximal diameter in consensus by two experienced radiologists. Using OsirixTM, volumetric measurements were done by one radiologist, including the entire infrarenal abdominal aorta. RESULTS: In 73 patients 220 CTA examinations were performed after EVAR with a mean follow-up of 17.3 months (range, 1.8-42.7 months). The mean postinterventional volume of aneurysm was 165.63 ml ± 93.29 ml (range, 47.94-565.67 ml). The mean maximal postinterventional diameter was 5.91 ± 1.52 cm (range, 3.72-13.82 cm). At large over the entire observation period a slight, non-significant decrease of 1.6% (2.58ml ± 69.05 ml, range 82.82-201.92 ml) in volumes and a 9.3% (mean 0.55 cm ± 1.22 cm, range 2.85-1.93cm) in diameters were observed. For all examinations a high correlation of volume and diameter was calculated (r = 0.813-0.905; α<0.01). CONCLUSION: For follow-up of abdominal EVAR using CTA there is a high correlation between volumetric and diametric measurements of aneurysm. Based on a daily clinical routine setting, measurements of maximal diameters in cross sectional imaging of AAA after EVAR seems to be sufficient to exclude post interventional enlargement.
Subject(s)
Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Adult , Aged , Aged, 80 and over , Analysis of Variance , Angiography, Digital Subtraction , Female , Follow-Up Studies , Humans , Male , Middle Aged , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
PURPOSE: To determine the practicability and outcome of fluoroscopic-guided primary one-step treatment of percutaneous gastrostomy (PG) with the system Freka® Gastro Tube (Fresenius Kabi, Germany). MATERIALS AND METHODS: In 39 patients (mean age 62.7 ± 12.0 years), primary PG was performed based on clinical indication from August 2009 to April 2010. The intervention was performed by an experienced radiologist under aseptic conditions by direct puncture with Freka® Gastro Tube under fluoroscopic guidance. The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. RESULTS: The intervention was technically successful in all 39 patients. Within the mean follow-up time of 155.3 ± 73.6 days, 29 patients (74.4 %) did not experience complications. 10 patients (25.6 %) had to be revised. Complications manifested after a mean of 135.6 ± 61.2 days and mainly corresponded to accidental dislocation (50 %). One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were 553.17 for our single-step treatment (OPS 5 - 431.x) vs. 963.69 (OPS 5 - 431.x and OPS 8 - 123.0) for the recommended two-step treatment. CONCLUSION: Fluoroscopic-guided primary single-step treatment with Freka® Gastro Tube system is feasible and not associated with an increased complication rate when compared to published literature applying a two-step treatment approach. Material costs as well as human and time resources could be significantly reduced using the single-step treatment.
