Endotension: twenty years of a controversial term

CVIR Endovascular - 2021
Álvaro Torres-Blanco1, M. Miralles-Hernández2
1Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario y Politécnico La Fe, Av/ Fernando Abril Martorell 106, 46026, Valencia, Spain
2Department of Surgery, University of Valencia, Valencia, Spain

Tóm tắt

AbstractUse of the term endotension in the treatment of aortic aneurysm is currently controversial. Initially it was proposed to define the circumstance in which there is an enlargement of the aneurysm sac after endovascular repair without a demonstrable endoleak. The term was established with the aim of transmitting the possibility of causes other than pressure applying stress to the aneurysm wall. Twenty years have passed since the proposal of this terminology was published. The literature is reviewed with the purpose of providing an update on advances in the knowledge of the possible etiological mechanisms. The experimental studies call into question that causes other than pressure determine the increase of the aneurysm. On the basis of this review, the term `Sac Expansion Without Evident Leak´ (SEWEL) is proposed as a more accurate and precise denomination for what is aimed to be defined. Evidence suggests that the more likely mechanisms of persistent pressurization of the aneurysm sac are an unidentified endoleak (likely type I or low-flow Type II) or thrombus occluding wide and short channels that connects with the excluded aneurysm sac (at the attachment sites of the stent-graft or at the branch vessels orifices).

Từ khóa


Tài liệu tham khảo

Abraha I, Luchetta ML, De Florio R, Cozzolino F, Casazza G, Duca P et al (2017) Ultrasonography for endoleak detection after endoluminal abdominal aortic aneurysm repair. Cochrane Database Syst Rev 6:CD010296

Armerding MD, Rubin GD, Beaulieu CF, Slonim SM, Olcott EW, Samuels SL, Jorgensen MJ, Semba CP, Jeffrey RB Jr, Dake MD (2000) Aortic aneurysmal disease: assessment of stent-graft treatment-CT versus conventional angiography. Radiology. 215(1):138–146. https://doi.org/10.1148/radiology.215.1.r00ap28138

Ashoke R, Brown LC, Rodway A, Choke E, Thompson MM, Greenhalgh RM, Powell JT (2005) Color duplex ultrasonography is insensitive for the detection of endoleak after aortic endografting: a systematic review. J Endovasc Ther 12(3):297–305. https://doi.org/10.1583/04-1479R.1

Bertges DJ, Chow K, Wyers MC, Landsittel D, Frydrych AV, Stavropoulos W, Tan WA, Rhee RY, Fillinger MF, Fairman RM, Makaroun MS (2003) Abdominal aortic aneurysm size regression after endovascular repair is endograft dependent. J Vasc Surg 37(4):716–723. https://doi.org/10.1067/mva.2003.212

Blackwood S, Mix D, Chandra A, Dietzek AM (2016) A model to demonstrate that endotension is a nonvisualized type I endoleak. J Vasc Surg 64(3):779–787. https://doi.org/10.1016/j.jvs.2015.04.422

Bosman WM, Hinnen JW, Rixen DJ, Hamming JF (2009) Effect of stent-graft compliance on endotension after EVAR. J Endovasc Ther 16(1):105–113. https://doi.org/10.1583/08-2505.1

Bredahl KK, Taudorf M, Lönn L, Vogt KC, Sillesen H, Eiberg JP (2016) Contrast Enhanced Ultrasound can Replace Computed Tomography Angiography for Surveillance After Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 52(6):729–734. https://doi.org/10.1016/j.ejvs.2016.07.007

Cho JS, Dillavou ED, Rhee RY, Makaroun MS (2004) Late abdominal aortic aneurysm enlargement after endovascular repair with the excluder device. J Vasc Surg 39(6):1236–1241; discussion 2141-2. https://doi.org/10.1016/j.jvs.2004.02.038

Chuter T, Ivancev K, Malina M, Resch T, Brunkwall J, Lindblad B, Risberg B (1997) Aneurysm pressure following endovascular exclusion. Eur J Vasc Endovasc Surg 13(1):85–87. https://doi.org/10.1016/S1078-5884(97)80056-1

Dangelmaier J, Bar-Ness D, Daerr H, Muenzel D, Si-Mohamed S, Ehn S, Fingerle AA, Kimm MA, Kopp FK, Boussel L, Roessl E, Pfeiffer F, Rummeny EJ, Proksa R, Douek P, Noël PB (2018) Experimental feasibility of spectral photon-counting computed tomography with two contrast agents for the detection of endoleaks following endovascular aortic repair. Eur Radiol 28(08):3318–3325. https://doi.org/10.1007/s00330-017-5252-7

Gawenda M, Jaschke G, Winter S, Wassmer G, Brunkwall J (2003) Endotension as a result of pressure transmission through the graft following endovascular aneurysm repair--an in vitro study. Eur J Vasc Endovasc Surg 26(5):501–505. https://doi.org/10.1016/S1078-5884(03)00378-2

Gawenda M, Knez P, Winter S, Jaschke G, Wassmer G, Schmitz-Rixen T, Brunkwall J (2004) Endotension is influenced by wall compliance in a latex aneurysm model. Eur J Vasc Endovasc Surg 27(1):45–50. https://doi.org/10.1016/j.ejvs.2003.10.013

Gilling-Smith G, Brennan J, Harris P, Bakran A, Gould D, McWilliams R (1999) Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention. J Endovasc Surg 6(4):305–307. https://doi.org/10.1583/1074-6218(1999)006<0305:EAEARD>2.0.CO;2

Guo Q, Zhao J, Huang B, Yuan D, Yang Y, Zeng G, Xiong F, du X (2016) A Systematic Review of Ultrasound or Magnetic Resonance Imaging Compared With Computed Tomography for Endoleak Detection and Aneurysm Diameter Measurement After Endovascular Aneurysm Repair. J Endovasc Ther 23(6):936–943. https://doi.org/10.1177/1526602816664878

Habets J, Zandvoort HJ, Reitsma JB, Bartels LW, Moll FL, Leiner T et al (2013) Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 45(04):340–350. https://doi.org/10.1016/j.ejvs.2012.12.014

Haider SE, Najjar SF, Cho JS, Rhee RY, Eskandari MK, Matsumura JS et al (2006) Sac behavior after aneurysm treatment with the Gore excluder low-permeability aortic endoprosthesis: 12-month comparison to the original excluder device. J Vasc Surg 44(4):694–700. https://doi.org/10.1016/j.jvs.2006.06.018

Harky A, Zywicka E, Santoro G, Jullian L, Joshi M, Dimitri S (2019) Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis. J Ultrasound 22(01):65–75. https://doi.org/10.1007/s40477-019-00364-7

Hogg ME, Morasch MD, Park T, Flannery WD, Makaroun MS, Cho JS (2011) Long-term sac behavior after endovascular abdominal aortic aneurysm repair with the excluder low-permeability endoprosthesis. J Vasc Surg 53(5):1178–1183. https://doi.org/10.1016/j.jvs.2010.11.045

Hynecek RL, Sadek M, Derubertis BG, Ryer EJ, Choi J, Hsu S et al (2007) Evaluation of pressure transmission and intra-aneurysmal contents after endovascular repair using the Trivascular Enovus expanded polytetrafluoroethylene stent graft in a canine model of abdominal aortic aneurysm. J Vasc Surg 46(5):1005–1013. https://doi.org/10.1016/j.jvs.2007.06.041

Iezzi R, Cotroneo AR, Filippone A, Di Fabio F, Quinto F, Colosimo C et al (2006) Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection? Radiology. 241(3):915–921. https://doi.org/10.1148/radiol.2413050959

Iezzi R, Cotroneo AR, Filippone A, Santoro M, Basilico R, Storto ML (2008) Multidetector-row computed tomography angiography in abdominal aortic aneurysm treated with endovascular repair: evaluation of optimal timing of delayed phase imaging for the detection of low-flow endoleaks. J Comput Assist Tomogr 32(4):609–615. https://doi.org/10.1097/RCT.0b013e31814b271d

Javor D, Wressnegger A, Unterhumer S, Kollndorfer K, Nolz R, Beitzke D, Loewe C (2017) Endoleak detection using single-acquisition split-bolus dual-energy computer tomography (DECT). Eur Radiol 27(04):1622–1630. https://doi.org/10.1007/s00330-016-4480-6

Karthikesalingam A, Al-Jundi W, Jackson D, Boyle JR, Beard JD, Holt PJ et al (2012) Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair. Br J Surg 99(11):1514–1523. https://doi.org/10.1002/bjs.8873

Katahashi K, Sano M, Takehara Y, Inuzuka K, Sugiyama M, Alley MT et al (2019) Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis. J Vasc Surg 70(01):107–116.e1

Kong LS, MacMillan D, Kasirajan K, Milner R, Dodson TF, Salam AA, Smith RB III, Chaikof EL (2005) Secondary conversion of the Gore excluder to operative abdominal aortic aneurysm repair. J Vasc Surg 42(4):631–638. https://doi.org/10.1016/j.jvs.2005.05.056

Kougias P, Bismuth J, Huynh TT, Lin PH (2008) Symptomatic aneurysm rupture without bleeding secondary to endotension 4 years after endovascular repair of an abdominal aortic aneurysm. J Endovasc Ther 15(6):702–705. https://doi.org/10.1583/08-2391.1

Lin PH, Bush RL, Katzman JB, Zemel G, Puente OA, Katzen BT, Lumsden AB (2003) Delayed aortic aneurysm enlargement due to endotension after endovascular abdominal aortic aneurysm repair. J Vasc Surg 38(4):840–842. https://doi.org/10.1016/S0741-5214(03)00468-3

Manning BJ, O'Neill SM, Haider SN, Colgan MP, Madhavan P, Moore DJ (2009) Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography. J Vasc Surg 49(1):60–65. https://doi.org/10.1016/j.jvs.2008.07.079

Marty B, Sanchez LA, Ohki T, Wain RA, Faries PL, Cynamon J, Marin ML, Veith FJ (1998) Endoleak after endovascular graft repair of experimental aortic aneurysms: does coil embolization with angiographic "seal" lower intraaneurysmal pressure? J Vasc Surg 27(3):454–461. https://doi.org/10.1016/S0741-5214(98)70320-9

May J, Harris JP (2012) Intermittent, posture-dependent, and late endoleaks after endovascular aortic aneurysm repair. Semin Vasc Surg 25(3):167–173. https://doi.org/10.1053/j.semvascsurg.2012.07.004

Mehta M, Ohki T, Veith FJ, Lipsitz EC (2001) All sealed endoleaks are not the same: a treatment strategy based on an ex-vivo analysis. Eur J Vasc Endovasc Surg 21(6):541–544. https://doi.org/10.1053/ejvs.2001.1349

Meier GH, Parker FM, Godziachvili V, Demasi RJ, Parent FN (2001) Gayle RG Endotension after endovascular aneurysm repair: the Ancure experience. J Vasc Surg 34(3):421–426. https://doi.org/10.1067/mva.2001.117145

Napoli V, Bargellini I, Sardella SG, Petruzzi P, Cioni R, Vignali C, Ferrari M, Bartolozzi C (2004) Abdominal aortic aneurysm: contrast-enhanced US for missed endoleaks after endoluminal repair. Radiology. 233(1):217–225. https://doi.org/10.1148/radiol.2331031767

Parodi JC, Berguer R, Ferreira LM, La Mura R, Schermerhorn ML (2001) Intra-aneurysmal pressure after incomplete endovascular exclusion. J Vasc Surg 34(5):909–914. https://doi.org/10.1067/mva.2001.119038

Pitton MB, Schweitzer H, Herber S, Schmiedt W, Neufang A, Kalden P, Thelen M, Düber C (2005) MRI versus helical CT for endoleak detection after endovascular aneurysm repair. AJR Am J Roentgenol 185(5):1275–1281. https://doi.org/10.2214/AJR.04.0729

Rhee RY, Eskandari MK, Zajko AB, Makaroun MS (2000) Long-term fate of the aneurysmal sac after endoluminal exclusion of abdominal aortic aneurysms. J Vasc Surg 32(4):689–696. https://doi.org/10.1067/mva.2000.110172

Risberg B, Delle M, Eriksson E, Klingenstierna H, Lönn L (2001) Aneurysm sac hygroma: a cause of endotension. J Endovasc Ther 8(5):447–453. https://doi.org/10.1177/152660280100800504

Rozenblit AM, Patlas M, Rosenbaum AT, Okhi T, Veith FJ, Laks MP, Ricci ZJ (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysm: value of unenhanced and delayed helical CT acquisitions. Radiology. 227(2):426–433. https://doi.org/10.1148/radiol.2272020555

Sakata M, Takehara Y, Katahashi K, Sano M, Inuzuka K, Yamamoto N, Sugiyama M, Sakahara H, Wakayama T, Alley MT, Konno H, Unno N (2016) Hemodynamic analysis of endoleaks after endovascular abdominal aortic aneurysm repair by using 4-dimensional flow-sensitive magnetic resonance imaging. Circ J 80(08):1715–1725. https://doi.org/10.1253/circj.CJ-16-0297

Sanchez LA, Faries PL, Marin ML, Ohki T, Parsons RE, Marty B, Soeiro D, Olivieri S, Veith FJ (1997) Chronic intraaneurysmal pressure measurement: an experimental method for evaluating the effectiveness of endovascular aortic aneurysm exclusion. J Vasc Surg 26(2):222–230. https://doi.org/10.1016/S0741-5214(97)70182-4

Thoo CH, Bourke BM, May J (2004) Symptomatic sac enlargement and rupture due to seroma after open abdominal aortic aneurysm repair with polytetrafluoroethylene graft: implications for endovascular repair and endotension. J Vasc Surg 40(6):1089–1094. https://doi.org/10.1016/j.jvs.2004.08.057

Trocciola SM, Dayal R, Chaer RA, Lin SC, DeRubertis B, Ryer EJ, Hynececk RL, Pierce MJ, Prince M, Badimon J, Marin ML, Fuster V, Kent KC, Faries PL (2006) The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene stent-grafts: characterization using a canine model. J Vasc Surg 43(1):109–116. https://doi.org/10.1016/j.jvs.2005.09.023

White GH, May J (2000) How should endotension be defined? History of a concept and evolution of a new term. J Endovasc Ther 7(6):435–438. https://doi.org/10.1177/152660280000700601

White GH, May J, Petrasek P, Waugh R, Stephen M, Harris J (1999) Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg 6(4):308–315. https://doi.org/10.1583/1074-6218(1999)006<0308:EAEFCA>2.0.CO;2

Williams GM (1998) The management of massive ultrafiltration distending the aneurysm sac after abdominal aortic aneurysm repair with a polytetrafluoroethylene aortobiiliac graft. J Vasc Surg 28(3):551–555. https://doi.org/10.1016/S0741-5214(98)70144-2

Yoshitake A, Hachiya T, Itoh T, Kitahara H, Kasai M, Kawaguchi S et al (2015) Nonvisualized type III endoleak masquerading as endotension: a case report. Ann Vasc Surg 29(3):595.e15–595.e17

Thông tin
Thông tin xuất bản

CVIR Endovascular

Thông tin tác giả