Diagnostic ultrasound ( PDFDrive )

440 PART II Abdominal and Pelvic Sonography
ENDOLEAKS
Type 1
Attachment leak
Type 2
Branch flow
A
B
Type 3
Defect in graft or
modular disconnection
Type 4
Fabric porosity
C
FIG. 12.9 Endoleaks of Abdominal Aortic Aneurysm After Endovascular Aneurysm Repair. (A) Type 1 leak (attachment leak). Blood
continues to enter the aneurysm sac at one of the three ends of the bifurcated stent graft, the points where the stent graft should be tightly afixed
to the arterial wall. Egress, as with all endoleaks, is through branches of the aorta that remain patent. Treatment of type 1 leaks is indicated.
(B) Type 2 leak (branch artery leak). Blood enters the aneurysm sac through a patent branch artery. This type of leak can be self-limited and
may be just observed. Treatment is indicated if the aneurysm enlarges. (C) Type 3 leak (loss of integrity of stent graft). Either the modules of
the stent graft have become separated or a rent has formed in the fabric of the stent graft. Blood enters the sac from the stent graft lumen through
the site of loss of stent graft integrity. Treatment is indicated. (D) Type 4 leak (fabric porosity). Blood enters the sac from the stent graft lumen
through intact cloth of the stent graft. This is self-limited and present only at surgery. The pores of the fabric quickly become occluded by blood
products.
D
with both included as part of a classiication referred to as chronic
periaortitis. 50-52 he newly discovered entity of immunoglobulin
G4 (IgG4)–related periaortitis and periarteritis likely is also
part of this complex. 53
Inlammatory AAAs are recognized by extremely thickened
aortic wall and surrounding ibrosis that tends to spare the
posterior wall (Fig. 12.13). As in retroperitoneal ibrosis, the
inlammation may involve the ureters, causing obstruction.
Inlammatory AAAs are less prone to rupture than other AAAs
but are more prone to producing symptoms such as back pain.
Antiinlammatory drugs, including steroids and methotrexate,
have been used to treat the inlammation. 50-52 With surgical or
endovascular treatment, the inlammation surrounding many
AAAs resolves (Fig. 12.14). 54 Sonographically, inlammatory
AAAs may be recognized by a rind of tissue surrounding the
aorta. Needle biopsy is usually necessary to conirm the diagnosis
and to exclude the small chance that the mass instead is due to
neoplasm, particularly lymphoma.
Arteriomegaly and Aortic Ectasia
Arteriomegaly is difuse arterial dilation involving several arteries,
each with an increased diameter of at least 50% compared with
the normal diameter. Ectasia refers to difuse or focal dilation
that is less than 50% increased in diameter. 4