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CompletedNCT02016131Updated Aug 21, 2025

CQDSA in Evaluation of Prognosis After EVAR

An observational study in Endoleak and Aortic Aneurysm, Abdominal, sponsored by Shanghai Zhongshan Hospital. Completed at 1 site in China. Open to participants aged 18 Years to 90 Years. Per ClinicalTrials.gov, last updated 2025-08-21.

Sponsored by Shanghai Zhongshan Hospital · Observational

Study type
Observational
Model
Case-control
Time perspective
Prospective
Enrollment
49
Ages
18 Years to 90 Years
Sex
All
01

Study summary

Re-hospitalization or re-intervention is sometimes necessary to treat type I and type III endoleaks after EVAR for its persistent increasing of pressure in aneurysm lumen. Color-coded quantitative digital subtraction angiography (CQDSA) provides an easy and quick way to post-process the traditional digital subtraction angiography (DSA) which converts the peak time of the maximal contrast medium intensity into a single polychromatic image. With the help of CQDSA, a quantitative evaluation of the endoleak hemodynamics and a risk analysis of the type I or type III endoleak could be performed during the EVAR procedure. This approach may offer an objective assessment of the needs for immediate re-intervention, conservative therapy or treatment endpoint in the future.

Read the detailed description

Intra-procedural DSA series are transferred to a research workstation to generate the color-coded images and make quantitative measurements. Region of interest (ROI) measurements are performed equivalently in the endoleak and the aorta after the image generation. There are three kinds of ROIs including a small circle area with the shortest time to peak, a circle area with peak contrast intensity and the whole endoleak area. The ROI and a reference at the same latitude within the aorta are selected to undergo measurement which reflected the endoleak hemodynamics of the endoleak to the utmost extent.

The following parameters will be acquired through the CQDSA for analysis.

  1. Time-versus-ROI contrast intensity graph. The graph contains one endoleak ROI flow curve and one reference aortic flow curve (Ref). The x-axis shows time from 0 second to the maximum frame time of the image. The y-axis shows the sum of pixel intensities, namely total contrast, representing the contrast concentration within the ROI.
  2. ROI Peak/Ref Peak. It is the ratio of intensity peak between the endoleak and the reference in the aorta.
  3. ROI TTP (Time to peak). Peak time of ROI in the vicinity of endoleak entry.
  4. ROI AUC/Ref AUC. Area under curve (AUC) is calculated through Time-versus-ROI contrast intensity graph. The parameter here is the ratio of ROI AUC in endoleak to the reference.
02

Conditions studied

  • Endoleak
  • Aortic Aneurysm, Abdominal

Keywords

  • endoleak
  • EVAR
  • AAA
  • CQDSA
03

Who can participate

Ages eligible
18 Years to 90 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Patients who present type I endoleak after EVAR for AAA.

Inclusion criteria

  • Patients who present type I or/and type III endoleak after EVAR for AAA and complete at least 3 months' follow up.

Exclusion criteria

Exclusion Criteria:

  • Patients who

    1. undergo surgeries which involve the segment covered by EVAR;
    2. present connective tissue disease, such as Marfan's Syndrome or vasculitis.
    3. present abdominal aortic dissection.
    4. present AAA rupture.
    5. die from non aneurysm-reltated reasons or are lost during follow up.
04

Study design

Observational model
Case-control
Time perspective
Prospective
Enrollment
49 participants (actual)
Patient registry
No

Groups and cohorts

  • none endoleak events

    Patients who have no further endoleaks related adverse events including aneurysm enlargement and rupture or persistent endoleaks.

  • Endoleak events

    Patients who undergo endoleaks related adverse events or persistent endoleaks during follow up.

05

What researchers measure

Primary outcomes

  1. Time-versus-ROI contrast intensity graph.

    The graph contains one endoleak ROI flow curve and one reference aortic flow curve (Ref). The x-axis shows time from 0 second to the maximum frame time of the image. The y-axis shows the sum of pixel intensities, namely total contrast, representing the contrast concentration within the ROI.

    Time frame: 15 seconds

  2. ROI Peak/Ref Peak

    It is the ratio of intensity peak between the endoleak and the reference in the aorta.

    Time frame: 15 seconds

  3. ROI TTP (Time to peak)

    Peak time of ROI in the vicinity of endoleak entry

    Time frame: 15 seconds

  4. ROI AUC/Ref AUC

    Area under curve (AUC) is calculated through Time-versus-ROI contrast intensity graph. The parameter here is the ratio of ROI AUC in endoleak to the reference.

    Time frame: 15 seconds

06

Study locations

1 site
  • Zhongshan Hospital
    Shanghai, 200032, China
07

References and documents

Publications

  • Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D, Krupski WC, Barone GW, Acher CW, Ballard DJ. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997 Mar 15;126(6):441-9. doi: 10.7326/0003-4819-126-6-199703150-00004. PubMed 9072929 ↗
  • Thompson AR, Cooper JA, Ashton HA, Hafez H. Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br J Surg. 2010 Jan;97(1):37-44. doi: 10.1002/bjs.6779. PubMed 20013940 ↗
  • Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT; UK Small Aneurysm Trial Participants. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation. 2004 Jul 6;110(1):16-21. doi: 10.1161/01.CIR.0000133279.07468.9F. Epub 2004 Jun 21. PubMed 15210603 ↗
  • Reed WW, Hallett JW Jr, Damiano MA, Ballard DJ. Learning from the last ultrasound. A population-based study of patients with abdominal aortic aneurysm. Arch Intern Med. 1997 Oct 13;157(18):2064-8. doi: 10.1001/archinte.157.18.2064. PubMed 9382661 ↗
  • Scott RA, Ashton HA, Lamparelli MJ, Harris GJ, Stevens JW. A 14-year experience with 6 cm as a criterion for surgical treatment of abdominal aortic aneurysm. Br J Surg. 1999 Oct;86(10):1317-21. doi: 10.1046/j.1365-2168.1999.01227.x. PubMed 10540141 ↗
  • Scott RA, Wilson NM, Ashton HA, Kay DN. Is surgery necessary for abdominal aortic aneurysm less than 6 cm in diameter? Lancet. 1993 Dec 4;342(8884):1395-6. doi: 10.1016/0140-6736(93)92756-j. PubMed 7901685 ↗
  • Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Lancet. 1998 Nov 21;352(9141):1649-55. PubMed 9853436 ↗
  • Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, Ballard DJ, Messina LM, Gordon IL, Chute EP, Krupski WC, Busuttil SJ, Barone GW, Sparks S, Graham LM, Rapp JH, Makaroun MS, Moneta GL, Cambria RA, Makhoul RG, Eton D, Ansel HJ, Freischlag JA, Bandyk D; Aneurysm Detection and Management Veterans Affairs Cooperative Study Group. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002 May 9;346(19):1437-44. doi: 10.1056/NEJMoa012573. PubMed 12000813 ↗
  • Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schlosser FJ, Setacci F, Ricco JB; European Society for Vascular Surgery. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011 Jan;41 Suppl 1:S1-S58. doi: 10.1016/j.ejvs.2010.09.011. No abstract available. PubMed 21215940 ↗
  • Jens S, Marquering HA, Koelemay MJ, Reekers JA. Perfusion angiography of the foot in patients with critical limb ischemia: description of the technique. Cardiovasc Intervent Radiol. 2015 Feb;38(1):201-5. doi: 10.1007/s00270-014-1036-5. Epub 2014 Dec 13. PubMed 25501266 ↗
  • Benndorf G. Color-coded digital subtraction angiography: the end of a monochromatic era? AJNR Am J Neuroradiol. 2010 May;31(5):925-7. doi: 10.3174/ajnr.A2077. Epub 2010 Apr 15. No abstract available. PubMed 20395396 ↗
  • Mehndiratta A, Knopp MV, Zechmann CM, Owsijewitsch M, von Tengg-Kobligk H, Zamecnik P, Kauczor HU, Choyke PL, Giesel FL. Comparison of diagnostic quality and accuracy in color-coded versus gray-scale DCE-MR imaging display. Int J Comput Assist Radiol Surg. 2009 Sep;4(5):457-62. doi: 10.1007/s11548-009-0356-4. Epub 2009 Jun 4. PubMed 20033528 ↗
  • Tenjin H, Asakura F, Nakahara Y, Matsumoto K, Matsuo T, Urano F, Ueda S. Evaluation of intraaneurysmal blood velocity by time-density curve analysis and digital subtraction angiography. AJNR Am J Neuroradiol. 1998 Aug;19(7):1303-7. PubMed 9726473 ↗
  • Strother CM, Bender F, Deuerling-Zheng Y, Royalty K, Pulfer KA, Baumgart J, Zellerhoff M, Aagaard-Kienitz B, Niemann DB, Lindstrom ML. Parametric color coding of digital subtraction angiography. AJNR Am J Neuroradiol. 2010 May;31(5):919-24. doi: 10.3174/ajnr.A2020. Epub 2010 Feb 18. PubMed 20167651 ↗
  • Khanafer KM, Bull JL, Upchurch GR Jr, Berguer R. Turbulence significantly increases pressure and fluid shear stress in an aortic aneurysm model under resting and exercise flow conditions. Ann Vasc Surg. 2007 Jan;21(1):67-74. doi: 10.1016/j.avsg.2006.10.009. PubMed 17349339 ↗
  • Hunter GJ, Hunter JV, Brown NJ. Parametric imaging using digital subtraction angiography. Br J Radiol. 1986 Jan;59(697):7-11. doi: 10.1259/0007-1285-59-697-7. PubMed 3512003 ↗
  • Veith FJ, Baum RA, Ohki T, Amor M, Adiseshiah M, Blankensteijn JD, Buth J, Chuter TA, Fairman RM, Gilling-Smith G, Harris PL, Hodgson KJ, Hopkinson BR, Ivancev K, Katzen BT, Lawrence-Brown M, Meier GH, Malina M, Makaroun MS, Parodi JC, Richter GM, Rubin GD, Stelter WJ, White GH, White RA, Wisselink W, Zarins CK. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002 May;35(5):1029-35. doi: 10.1067/mva.2002.123095. PubMed 12021724 ↗
  • Hinnen JW, Koning OH, van Bockel JH, Hamming JF. Aneurysm sac pressure after EVAR: the role of endoleak. Eur J Vasc Endovasc Surg. 2007 Oct;34(4):432-41; discussion 442-3. doi: 10.1016/j.ejvs.2007.05.022. Epub 2007 Aug 1. PubMed 17669670 ↗
  • Zhou M, Su Z, Shi Z, Fu W, Meng X, Wang Y, Guo B, Huang K. Application of color-coded quantitative digital subtraction angiography in predicting the outcomes of immediate type I and type III endoleaks. J Vasc Surg. 2017 Sep;66(3):760-767. doi: 10.1016/j.jvs.2016.11.048. Epub 2017 Feb 16. PubMed 28216350 ↗
08

Registry details

Key details

Study ID
NCT02016131
Lead sponsor
Shanghai Zhongshan Hospital
Collaborators
Siemens Ltd., China, Shanghai, China.
Responsible party
Zhenyu Shi (Associate Prof., Shanghai Zhongshan Hospital) — Principal investigator
First posted
Dec 19, 2013
Start date
Jan 2012
Primary completion
Sep 2014
Completion
Mar 2015
Last update
Aug 21, 2025

Study contacts

Weiguo Fu, MD
study chair · Shanghai Zhongshan Hospital

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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