Endoleak and thrombus characterization with dynamic elastography after endoleak embolization following aneurysm endovascular repair
Year: 2016
Type: article
Abstract: Event Abstract Back to Event Endoleak and thrombus characterization with dynamic elastography after endoleak embolization following aneurysm endovascular repair Antony Bertrand-Grenier1, 2, 3, 4, Fatemeh Zehtabi1, 5, 6, Claude Kauffman1, 3, Hélène Héon1, Guy Cloutier1, 2, 7, 8, Sophie Lerouge1, 5, 6 and Gilles Soulez1, 3, 7, 8, 9 1 Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Canada 2 CRCHUM, Laboratoire de Biorhéologie et d’Ultrasonographie Médicale (LBUM), Canada 3 CRCHUM, Laboratoire Clinique de Traitement d’Images (LCTI), Canada 4 Université de Montréal, Département de Physique, Canada 5 CRCHUM, Laboratoire de Biomatériaux EndoVasculaire (LBEV), Canada 6 École de technologie supérieure (ÉTS), Département de génie mécanique, Canada 7 Université de Montréal, Institut de Génie Biomédical, Canada 8 Université de Montréal, Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Canada 9 Centre hospitalier de l’Université de Montréal (CHUM), Département de Radiologie, Canada Purpose: SuperSonic Imagine (SSI) measure the tissue elasticity in real-time[1]. The goal of this study was to characterize in a canine model of aneurysm endovascular repair (EVAR) residual endoleak[2] and thrombus organization[3] with SSI after endoleak embolization and correlate results with CT-Scan, Doppler Ultrasound (DUS) and pathologic findings. Materials and Methods: EVAR was done with creation of type I endoleak in eighteen aneurysms created in nine dogs (common iliacs arteries)[4]. Two embolization gels (Chitosan (Chi) or Chitosan-Sodium-Tetradecyl-Sulfate (Chi-STS)) were injected in the sac to seal the endoleak and promote healing[5]. SSI and DUS were performed at baseline (implantation, 1-week, 1-month, 3-months) whereas angiography and CT-scan were performed at sacrifice. Macroscopic and histopathological analyses were processed to identify and segment five different regions of interest (ROIs) (endoleak, fresh or organized thrombus, Chi or Chi-STS). Elasticity modulus values were compared. Results: At sacrifice, 10 aneurysms had type I endoleaks, 9 had fresh thrombus, 15 had organized thrombus and 3 were completely sealed. SSI was able to detect all endoleaks seen on CT-scan and macroscopic cuts. We found elastic moduli (in kPa) of 0.1 ± 0.2, 9.2 ± 3.5, 47.3 ± 25.7, 55.9 ± 21.7 and 69.6 ± 29.0 in endoleak, fresh thrombus, organized thrombus, Chi and Chi-STS regions at 3 months, respectively. Elasticity values of endoleak and fresh thrombus were significantly lower than others ROIs (p < 0.001). Figure 1 displays an AAA with different ROIs visualized with SSI. Figure 2 shows an aneurysm with massive fresh thrombus detected as an area of lower stiffness. Elasticity values of fresh thrombus ranged between 3 and 19 kPa (8.7 ± 3.6 kPa) at 1-week and 30.2 ± 13.8 kPa at 3-months indicating that SSI can evaluate thrombus maturation. Figure 1. Images from an aneurysm with endoleak (green arrow), chitosan (white arrow), chitosan less organized (yellow arrow) and organized thrombus (black arrow). Endoleak and fresh thrombus were visualized on SSI. Areas filled with Chi were slightly hyper echoic and with endoleak were anechoic on B-mode US. (A) Macroscopic cut. (B) CT-scan. (C) DUS. (D) B-mode US. (E) SSI. (F) Color scale values for SSI. Figure 2. Axial views of the different techniques from an aneurysm with massive fresh thrombus and a small endoleak saw on SSI. (A) Macroscopic cut. (B) CT-scan. (C) DUS. (D) B-mode US. (E) SSI. (F) Color scale values for SSI. The green, red and white arrows indicate endoleak, fresh thrombus and chitosan, respectively. Conclusion: The results confirm that SSI was able to evaluate thrombus organization and embolization agents over time after endoleak embolization following EVAR. A lower elastic modulus value corresponds to fresh thrombus wheres a higher value corresponds to organized thrombus. Clinical Relevance: The SSI can complement conventional DUS in post-EVAR surveillance. It could reduce the cost, the exposition to ionizing radiation and nephrotoxic contrast agents of surveillance CT-scan follow-up. Fonds de Recherche du Québec en Santé (FRQS); Canadian Institutes of Health ResearchReferences:[1] Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY. Shear wave elasticity imaging: A new ultrasonic technology of medical diagnostics. Ultrasound Med Biol. 1998;24:1419-1435.[2] White GH, Yu W, May J, et al. Endoleaks as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 1997;4:152-68.[3] White GH. What are the causes of endotension? J Endovasc Ther 2001;8:454-6.[4] Lerouge S, Raymond J, Salazkin I, Qin Z, Gaboury L, Cloutier G, et al. Endovascular aortic aneurysm repair with stent-grafts: experimental models can reproduce endoleaks. J Vasc Interv Radiol 2004;15:971–9.[5] Fatimi A, Chabrot P, Berrahmoune S, Coutu JM, Soulez G, Lerouge S. A new injectable radiopaque chitosan-based sclerosing embolizing hydrogel for endovascular therapies. Acta Biomater. 2012 Jul;8(7):2712-21. Keywords: Hydrogel, mechanical property, in vivo tissue engineering, Imaging method Conference: 10th World Biomaterials Congress, Montréal, Canada, 17 May - 22 May, 2016. Presentation Type: General Session Oral Topic: Biomaterials for cardiovascular applications, vascular grafts and embolic devices Citation: Bertrand-Grenier A, Zehtabi F, Kauffman C, Héon H, Cloutier G, Lerouge S and Soulez G (2016). Endoleak and thrombus characterization with dynamic elastography after endoleak embolization following aneurysm endovascular repair. Front. Bioeng. Biotechnol. Conference Abstract: 10th World Biomaterials Congress. doi: 10.3389/conf.FBIOE.2016.01.00018 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Mar 2016; Published Online: 30 Mar 2016. Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Antony Bertrand-Grenier Fatemeh Zehtabi Claude Kauffman Hélène Héon Guy Cloutier Sophie Lerouge Gilles Soulez Google Antony Bertrand-Grenier Fatemeh Zehtabi Claude Kauffman Hélène Héon Guy Cloutier Sophie Lerouge Gilles Soulez Google Scholar Antony Bertrand-Grenier Fatemeh Zehtabi Claude Kauffman Hélène Héon Guy Cloutier Sophie Lerouge Gilles Soulez PubMed Antony Bertrand-Grenier Fatemeh Zehtabi Claude Kauffman Hélène Héon Guy Cloutier Sophie Lerouge Gilles Soulez Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W2323665937