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2. van Marrewijk C, Buth J, Harris PL, Norgren L, Nevelsteen A, Wyatt MG. Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 2002; 35:461– 473. 3. Baum RA, Carpenter JP, Golden MA, et al. Treatment of type 2 en- doleaks after endovascular repair of abdominal aortic aneurysms: com- parison of transarterial and translumbar techniques. J Vasc Surg 2002; 35:23–29. 4. Martin ML, Dolmatch BL, Fry PD, Machan LS. Treatment of type II endoleaks with Onyx. J Vasc Interv Radiol 2001; 12:629 – 632. 5. Kasirajan K, Matteson B, Marek JM, Langsfeld M. Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg 2003; 38:61– 66. 6. Stavropoulos SW, Kim H, Clark TW, Fairman RM, Velazquez O, Carpenter JP. Embolization of type 2 endoleaks after endovascular repair of ab- dominal aortic aneurysms with use of cyanoacrylate with or without coils. J Vasc Interv Radiol 2005; 16:857– 861. 7. Gorlitzer M, Mertikian G, Trnka H, et al. Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm. Interact Cardiovasc Thorac Surg 2008; 7:781–784. 8. Nevala T, Biancari F, Manninen H, et al. Type II endoleak after endo- vascular repair of abdominal aortic aneurysm: effectiveness of emboliza- tion. Cardiovasc Intervent Radiol 2010; 33:278 –284. 9. Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleak embolization comparison: translumbar embolization versus modified transarterial embolization. J Vasc Interv Radiol 2009; 20:1299 –1302. 10. Rosen RJ, Green RM. Endoleak management following endovascular aneurysm repair. J Vasc Interv Radiol 2008; 19(suppl):S37–S43. 11. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interven- tional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14(suppl):S199 –S202. 12. Bent CL, Jaskolka JD, Lindsay TF, Tan K. The use of dynamic volumet- ric CT angiography (DV-CTA) for the characterization of endoleaks follow- ing fenestrated endovascular aortic aneurysm repair (f-EVAR). J Vasc Surg 2010; 51:203–206. CME TEST QUESTIONS: JULY 2012 Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username and password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center, click on the “Publication” activity type for a listing of all available JVIR CME Tests. Each test will be available online for three years from the month/date of publication. The CME questions in the July issue are derived from the article “Evaluation and Treatment of Suspected Type II Endoleaks in Patients with Enlarging Abdominal Aortic Aneurysms” by Funaki et al. 1. For this study, the authors define sac enlarge- ment as: a) More than a 5-mm increase in the largest axial sac diameter compared to that on the most recent prior CT. b) More than a 5-mm increase in the largest axial sac diameter compared to that on the immediate post- procedure CT. c) More than a 5% increase in the largest sac diameter along the aortic centerline compared to that on the most recent prior CT. d) More than a 5% increase in the largest sac diameter along the aortic centerline compared to that on the immediate postprocedure CT. 2. With regard to technical successes: a) Transarterial embolization had better success than direct aneurysm puncture. b) Direct aneurysm puncture had better success than transarterial embolization. c) Some technical successes were clinical failures. d) Some technical failures were clinical successes. 3. An encouraging, but unexpected finding noted by the authors was: a) Pre-procedural CT well predicted treatment success. b) The endoleak feeding artery was usually easily identified on the planning CT. c) Type III endoleaks, which were detected after treatment of suspected type II endoleaks, were also incidentally successfully treated. d) Unsuspected type I endoleaks were easily treated concomitantly during transarterial embolization of type II leaks. 4. Reasons why endoleaks may have been misclassified include all of the following EXCEPT: a) Findings of different types of endoleaks may have similar findings on CT. b) Type II endoleaks are much more common than other types. c) Even with angiography, type II and type III en- doleaks may be indistinguishable. d) Focal type I endoleaks may mask concurrent type II endoleaks. 872 Suspected Type II Endoleaks in Patients with Enlarging AAAs Funaki et al JVIR

CME Test Questions: July 2012

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872 � Suspected Type II Endoleaks in Patients with Enlarging AAAs Funaki et al � JVIR

2. van Marrewijk C, Buth J, Harris PL, Norgren L, Nevelsteen A, Wyatt MG.Significance of endoleaks after endovascular repair of abdominal aorticaneurysms: the EUROSTAR experience. J Vasc Surg 2002; 35:461–473.

3. Baum RA, Carpenter JP, Golden MA, et al. Treatment of type 2 en-doleaks after endovascular repair of abdominal aortic aneurysms: com-parison of transarterial and translumbar techniques. J Vasc Surg 2002;35:23–29.

4. Martin ML, Dolmatch BL, Fry PD, Machan LS. Treatment of type IIendoleaks with Onyx. J Vasc Interv Radiol 2001; 12:629–632.

5. Kasirajan K, Matteson B, Marek JM, Langsfeld M. Technique andresults of transfemoral superselective coil embolization of type II lumbarendoleak. J Vasc Surg 2003; 38:61–66.

6. Stavropoulos SW, Kim H, Clark TW, Fairman RM, Velazquez O, CarpenterJP. Embolization of type 2 endoleaks after endovascular repair of ab-dominal aortic aneurysms with use of cyanoacrylate with or without coils.J Vasc Interv Radiol 2005; 16:857–861.

II endoleaks after endovascular repair of abdominal aortic aneurysm.Interact Cardiovasc Thorac Surg 2008; 7:781–784.

8. Nevala T, Biancari F, Manninen H, et al. Type II endoleak after endo-vascular repair of abdominal aortic aneurysm: effectiveness of emboliza-tion. Cardiovasc Intervent Radiol 2010; 33:278–284.

9. Stavropoulos SW, Park J, Fairman R, Carpenter J. Type 2 endoleakembolization comparison: translumbar embolization versus modifiedtransarterial embolization. J Vasc Interv Radiol 2009; 20:1299–1302.

0. Rosen RJ, Green RM. Endoleak management following endovascularaneurysm repair. J Vasc Interv Radiol 2008; 19(suppl):S37–S43.

1. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interven-tional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14(suppl):S199–S202.

2. Bent CL, Jaskolka JD, Lindsay TF, Tan K. The use of dynamic volumet-ric CT angiography (DV-CTA) for the characterization of endoleaks follow-ing fenestrated endovascular aortic aneurysm repair (f-EVAR). J Vasc

7. Gorlitzer M, Mertikian G, Trnka H, et al. Translumbar treatment of type Surg 2010; 51:203–206.

CME TEST QUESTIONS: JULY 2012

Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIRLearning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username andpassword, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center,click on the “Publication” activity type for a listing of all available JVIR CME Tests. Each test will be available onlinefor three years from the month/date of publication.

The CME questions in the July issue are derived from the article “Evaluation and Treatment of Suspected Type IIEndoleaks in Patients with Enlarging Abdominal Aortic Aneurysms” by Funaki et al.

1. For this study, the authors define sac enlarge-ment as:a) More than a 5-mm increase in the largest axial

sac diameter compared to that on the most recentprior CT.

b) More than a 5-mm increase in the largest axial sacdiameter compared to that on the immediate post-procedure CT.

c) More than a 5% increase in the largest sac diameteralong the aortic centerline compared to that on themost recent prior CT.

d) More than a 5% increase in the largest sac diameteralong the aortic centerline compared to that on theimmediate postprocedure CT.

2. With regard to technical successes:a) Transarterial embolization had better success than

direct aneurysm puncture.b) Direct aneurysm puncture had better success than

transarterial embolization.c) Some technical successes were clinical failures.d) Some technical failures were clinical successes.

3. An encouraging, but unexpected finding noted by theauthors was:a) Pre-procedural CT well predicted treatment success.b) The endoleak feeding artery was usually easily

identified on the planning CT.c) Type III endoleaks, which were detected after

treatment of suspected type II endoleaks, were alsoincidentally successfully treated.

d) Unsuspected type I endoleaks were easily treatedconcomitantly during transarterial embolization oftype II leaks.

4. Reasons why endoleaks may have been misclassifiedinclude all of the following EXCEPT:a) Findings of different types of endoleaks may have

similar findings on CT.b) Type II endoleaks are much more common than

other types.c) Even with angiography, type II and type III en-

doleaks may be indistinguishable.d) Focal type I endoleaks may mask concurrent type

II endoleaks.