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Objectives: to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the detection of type II endoleaks during follow-up after endovascular treatment of intra-renal aortic aneurysms. Design: prospective study. Material and methods: between March 1996 and November 1999, 31 patients with infra-renal aortic aneurysms who underwent stentgraft implantation were followed with helical CT and MRI, including magnetic resonance angiography (MRA), at 1 and 6 months after the procedure. Arteriography was performed between 6 and 12 months after intervention. The parameters studied included the change in the maximum anteroposterior and transverse diameters, the nature of the signal on T1 and T2 weighted sequences (homogeneous vs heterogeneous), the presence or absence of Gadolinium uptake on MRI or of contrast uptake on helical CT (early and late phases) in the sac of the aneurysm. On MRA, stentgraft patency and endoleak detection were studied. Results: arteriography demonstrated an endoleak in 19 patients (18 type II, and 1 type I endoleak). MRI at 6 months detected 18/19 endoleaks on T1 weighted sequences after injection of Gadoliniumj; there were 2 false positives. MRA sequences confirmed stentgraft patency in all patients, but did not diagnose type II endoleaks. Helical CT (late phase) at 6 months detected 10/19 endoleaks; there was 1 false positive. The sensitivity of MRI after injection of Gadolinium and of helical CT for the detection of type II endoleaks were 94% and 50% (p=0.003) respectively. The mean maximal anteroposterior and transverse diameters were similar on MRI and on helical CT at 1 month and at 6 months. Conclusion: MRI after injection of Gadolinium is more sensitive than helical CT in the detection of type II endoleaks after stentgraft implantation. Its more widespread use may permit earlier intervention in such patients.

After endovascular treatment of AAA, regular clinical and radiologic surveillance is necessary for early diagnosis and treatment of mid-term and long-term complications. The purpose of this report was to evaluate the efficacy of magnetic resonance imaging (MRI) in screening for type II endoleaks and assessing the results of treatment by embolization. From March 1996 to November 1999, 64 patients with uncomplicated infrarenal abdominal aortic aneurysm (AAA) were treated by endovascular exclusion with a covered aortic stent. Radiological surveillance included plain abdominal roentgenogram (PAR), CT scan, and pelvioabdominal MRI at 1 month, 3 months, 6 months, and every 6 months thereafter. Arteriography was performed routinely after 1 year or sooner if an endoleak was suspected. Based on the results of this study, MRI seems to be more sensitive than CT scanning for detection of type II endoleaks. The negative predictive value of MRI is also better. In this series, all endoleaks were treated by embolization. In most cases, the maximum transverse diameter and maximum anteroposterior diameter decreased after embolization. Further follow-up will be necessary to confirm these findings.

Background Aortic dissection is a well rare disease with pour mid and long term prognosis. The treatment of initial phase of acute aortic syndrom (AAS) affecting the descending aorta is essentially based on lowering blood pressure and on relieving pain. The emergence of endovascular therapy offers new perspectives in the management of this old disease. Few data exist on the long term prognosis of patients who discharge alive after a medical treatment of a type B AAS. The aim of our study was to determine factors of the acute phase associated with adverse long term survival. Methods and Results We study the long term outcome of 77 patients, hospitalized in our center from 1996 to 2008, who discharge alive after type B AAS. All patients received a medical treatment and an endovascular therapy if needed. The mean follow-up period was 50.8 month, with a survival rate of 78%. Kaplan-Meier survival curves were constructed, and Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality from any cause. Factors that influence the mortality (p Conclusion Patients who discharge alive after medically treated type B acute aortic disease keep a worse mid and long term prognosis. Our study identifies new risk factors of mortality after discharge, and a population at very high risk. The treatment of the acute phase needs further study to better understand and optimize care of this patients.

Objectifs Evaluer les resultats de la fenestration dans les dissections aortiques avec syndrome de malperfusion aigu. Materiels et methodes Entre 1999 et 2007, 36 patients (32 hommes ; 57+/-11 ans) avec dissection aortique (type A 21 ; type B 15) etaient traites par fenestration pour syndrome de malperfusion (renal 28 ; digestif 27 ; membres inferieurs 14) lie a une compression dynamique. La fenestration etait realisee avec 2 guides rigides introduits dans un introducteur 8F. Le delai entre la dissection et la fenestration etait de 5 jours (28 patients Resultats La fenestration (succes technique 100 %) associee a des gestes complementaires (stents peripheriques 26, stent graft thoracique 1, chirurgie digestive 5) permettait un succes angiographique dans 97 %. La mortalite dans le premier mois (11/36) etait liee aux complications digestives (5), neurologiques (2), post-chirurgicales (type A, 2) et multiviscerales (2). Au cours du suivi (moyenne 45 mois), 5/25 patients etaient decedes. Le diametre aortique (thoracique 45 mm+/-11, abdominal 34 mm+/-10), mesure par TDM/IRM, restait stable chez 20/25 et augmentait chez 5/25 (1 Marfan, 2 patients avec ectasies arterielles multiples). Conclusion La fenestration permettait une survie chez 69 % des patients. Au cours du suivi, le diametre aortique restait stable chez la majorite des patients survivants.

Objectifs Rapporter les resultats sur 5 ans d’une etude monocentrique concernant les indications, les taux de morbi-mortalite de l’implantation d’endoprotheses dans l’aorte thoracique descendante. Materiels et methodes Quatre vingt trois patients presentant une contre-indication chirurgicale, porteurs d’une lesion de l’aorte thoracique descendante (dissection aortique (n = 28), anevrisme thoracique (n = 16), faux anevrisme (n = 15), hematome dissequant (n = 5), rupture isthmique (n = 11) ulcere penetrant (n = 7), rupture aortique post chirurgicale (n = 1)) etaient traites par mise en place d’endoprotheses (endoprothese Medtronic (n = 77), Cook (n = 5), Gore (n = 1)) apres consensus multidisciplinaire. Resultats Le succes technique etait de 100 %. Un geste associe etait effectue dans 5 cas (stenting renal, embolisation, pontage carotido-sous-clavier). Au suivi precoce, une intervention complementaire etait necessaire dans 5 cas avec implantation d’une autre endoprothese pour persistance d’une rupture aortique. Les complications immediates etaient une rupture iliaque (n = 3), une dissection retrograde (n = 1), un hematome intra-musculaire (n = 1), et une paraplegie pour 1 patient beneficiant d’une reparation concomitante d’un anevrisme abdominal. Les complications tardives etaient une migration d’endoprothese (n = 2) et une fuite (n = 7). Le taux de mortalite precoce etait de 8 % (n = 7) pour un total de 16 % (n = 13) sur une periode d’un an. Conclusion La mise en place d’endoprotheses aortiques thoraciques apparait efficace et prometteuse pour le traitement de diverses lesions de l’aorte descendante.