Endoleaks after endovascular aneurysm repair lead to nonuniform intra-aneurysm sac pressure

Flow chart shows patients undergoing direct intra-aneurysm sac pressure measurements (DISP) according to the type of endoleak (EL) and abdominal aortic aneurysm (AAA) diameter change. Six patients underwent DISP after successful embolization of type II endoleaks. *Two patients with type II endoleaks underwent DISP twice; the initial measurement was after AAA diameter shrinkage, and the second occurred once the AAA had expanded.

A, Digital subtraction angiography shows contrast injection inside a type II endoleak nidus (arrowheads) through a translumbar puncture of the abdominal aortic aneurysm at the time of direct intra-aneurysm sac pressure measurement. Two lumbar arteries are filled (arrows). B, Status after embolization of the endoleak with Histoacryl (Braun, Tuttlingen, Germany) and Lipiodol (Laboratoire Guerbet, Aulnay-Sous-Bois, France). The glue fills the endoleak nidus and the proximal part of two lumbar arteries (arrow).

Recording from direct intra-aneurysm pressure measurement. A, Measurement within the thrombus. B, Measurement in the endoleak nidus. Red curves represent the aortic pressure, and green curves represent the intra-aneurysm sac pressure. Each figure has three tracings. The large one to the left is the tracing obtained during each recording where the aortic and intra-aneurysm sac pressures are registered simultaneously. The pressure recorded during 10 heart cycles is gathered separately in two different tracings, one for the aortic (upper smaller tracing to the right) and the other intra-aneurysm sac pressures (lower smaller tracing to the right). The system calculates also the mean of the systolic, diastolic, and mean pressures for both the aortic and intra-sac pressures (values below the small tracings). In the smaller tracings the scale is adjusted by the software to the amplitude of the curves.