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Quantitative evaluation of endoleakage by transesophageal echocardiography during thoracic endovascular aortic repair.
Hiroto Kitahara1, Kenichi Hashizume1, Shinya Inoue1, Atsushi Nemoto1, Kanako Hayashi1, Ryusuke Hosoda1, Hiroaki Kaneyama1, Hideyuki Shimizu2.
1Saiseikai Utsunomiya Hospital, Tochigi, Japan, 2Keio University School of Medicine, Tokyo, Japan.

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has been a standard therapy for thoracic aortic aneurysm. However, post-operative endoleak occurs frequently, and it affects the long-term outcome. Although, trans-esophageal echocardiography (TEE) is known as a useful modality during TEVAR, there is no report describing the quantitative evaluation of endoleak by TEE. In this study, we hypothesized that the high-velocity flow (HVF) measured by TEE in the aneurysmal sac is associated with post-operative endoleak.
METHODS: Consecutive 246 patients who underwent TEVAR between December 2009 and August 2015 were reviewed. In these patients, 56 patients were evaluated intra-operatively by TEE from July 2014. These patients were divided into two groups, (i) group nEL consisted of patients with no endoleak by angiography (N=46), and (ii) group EL with endoleak by angiography (N=10). HVF was measured by TEE. Postoperative remaining endoleak was detected by computed tomography scan. To determine the cutoff point of HVF, receiver-operating characteristic (ROC) was analyzed with HVF and post-operative endoleak.
RESULTS: There were no significant differences between the preoperative characteristics of two groups, except sex (group EL VS group nEL, 80% VS 76%, P=0.02). In the group EL, endoleak type 1, 2, 3, and 4 were detected in 3, 1, 4, and 2 patients respectively. Cutoff point of HVF was calculated to 30.3 cm/s by ROC analysis (sensitivity 0.8, and specificity 0.45).
CONCLUSIONS: We evaluated endoleak quantitatively by using HVF with TEE. HVF is useful value to find out small endoleak, which was not detected by angiography. This value may give a meaningful information that endoleak should be treated or not.

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