The aim of this study is to understand that Detection of an endoleak source depends on the timing of the image acquisition to coincide with the arrival time of contrast material, which is dictated by numerous factors. Triphasic computed tomography angiography (T-CTA) cannot always determine the flow dynamics and source vessels. Dynamic, time-resolved CTA (D-CTA) allows the surgeon to see contrast enhancement patterns in multiple time points and to target the principal inflow sources (Fig). The objective of this study was to assess the diagnostic accuracy of D-CTA and its effect on the guidance of endoleak treatment compared with T-CTA.

Prospectively collected data were analyzed of 17 patients who underwent endovascular reintervention after endovascular aortic repair for endoleak and aneurysm sac expansion between May 2017 and February 2020. Ten patients had T-CTA (three time points: nonenhanced, peak arterial, and 60-second delay) and seven patients had D-CTA (10-13 time points; Somatom Force [Siemens Healthineers, Erlangen, Germany]) before the intervention. Endoleak type and source were analyzed by an expert cardiovascular imaging specialist (S.C.) based on preoperative imaging studies. Subsequently, this was compared with the intraoperative findings. Procedural success, number of diagnostic angiographic runs for the confirmation of the endoleak, and radiation exposure (mean dose-area product) were compared between the two groups.

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