Endoleak - types of endoleaks after endovascular aneurysm repair (EVAR)

The term "endoleak" was proposed in 1996 by White et al. in a letter to editor, where the authors described its basic types. It refers to a failure of endovascular aneurysm repair (EVAR) with persistent blood flow within an aneurysm sac but outside the lumen of the endoluminal graft. Persistent endoleak causes continued pressurization of the aneurysm with the risk of its rupture as a consequence.

Type Subtype Description
Type I  

Myocardial collateral flow - Rentrop grading of collateral filling from the contralateral vessel on coronary angiography in coronary artery occlusion

Rentrop et al. researched collateral filling of stenotic coronary artery during inflation of the PTA balloon. Contrast dye was injected as soon as the patient developed ST-T changes on ECG or angina, but no later than 90 seconds after inflation of the balloon.

Grades of collateral filling Description
0 none
1 filling of side branches of the artery via collateral channels without visualisation of the epicardial segment

Myocardial blush grade - grading of myocardial perfusion during coronary angiography

Myocardial blush grade evaluates contrast density in the myocardial region of the infarct-related artery compared to regions of noninfarct-related arteries on coronary angiography.

Myocardial blush grade - MBG Description
MBG 0 no myocardial blush (or contrast density) or persisting blush (staining)
MGB 1 minimal myocardial blush (or contrast density)

TIMI frame count - evaluation of coronary blood flow during coronary angiography

TIMI frame count is an alternative to the TIMI flow. Unlike TIMI flow, it offers a quantitative assessment of coronary artery blood flow. TIMI frame count is expressed as the number of frames required for dye to reach a standardized distal landmark in a coronary artery.

The first frame is counted when the dye touches both border of the coronary artery and moves forward with at least 70% opacification of the vessel lumen.
The last frame is counted when the dye enters the standardized distal landmark:

TIMI grade flow - grading of coronary blood flow during coronary angiography

This TIMI classification was developed by the TIMI (Thrombolysis In Myocardial Infarction) study group to semiquantitatively assess coronary artery perfusion beyond point of occlusion on coronary angiography.

TIMI Grade Description
TIMI 0 - no perfusion no antegrade flow beyond the point of occlusion
TIMI 1 - penetration without perfusion

Coronary artery dissection - NHLBI classification (The National Heart, Lung and Blood Institute)

This classification divides dissection of coronary artery into six types based on their appearance on coronary angiography.

Type Description
Type A minor radiolucent areas in the lumen without impairment of flow or persistant dye staining after contrast runoff
Type B luminal flap that is radiolucent and runs parallel to the vessel wall with contrast injection but without impairment of flow or persistant dye staining after contrast runoff
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