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Cruz J, McGillen K, Pryor W, Esslinger D, Shin B. Novel use of contrast-enhanced ultrasound in the pretreatment planning prior to endovascular repair of endoleak after endovascular aortic aneurysm repair in a patient with chronic renal insufficiency: A case report and literature review. J Med Ultrasound 2022; 30:54-58. [PMID: 35465604 PMCID: PMC9030361 DOI: 10.4103/jmu.jmu_173_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/17/2021] [Accepted: 03/02/2021] [Indexed: 11/04/2022] Open
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Frenzel F, Kubale R, Massmann A, Raczeck P, Jagoda P, Schlueter C, Stroeder J, Buecker A, Minko P. Artifacts in Contrast-Enhanced Ultrasound during Follow-up after Endovascular Aortic Repair: Impact on Endoleak Detection in Comparison with Computed Tomography Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:488-498. [PMID: 33358051 DOI: 10.1016/j.ultrasmedbio.2020.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
The study described here systematically analyzed how specific artifacts in contrast-enhanced ultrasound (CEUS) can affect the detection of endoleaks during follow-up after endovascular aortic repair (EVAR). Patients undergoing EVAR of atherosclerotic or mycotic abdominal aortic aneurysms using various standard and branched stent-graft material for visceral and iliac preservation were enrolled over 5 y and followed up with computed tomography angiography (CTA) and CEUS simultaneously. CEUS artifacts were frequently identified after EVAR procedures (59% of examinations) and were caused mainly by contrast agent, different prosthesis or embolization material and postinterventional changes in the aneurysm sac. This article describes how to identify important artifacts and how to avoid false-negative or false-positive interpretations of endoleaks. Despite artifacts, CEUS had higher sensitivity for endoleak detection after EVAR than CTA. CEUS was superior to CTA in the identification of late endoleaks type II and in follow-up examinations after embolization procedures, where beam-hardening artifacts limited CTA.
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Affiliation(s)
- Felix Frenzel
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany.
| | - Reinhard Kubale
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Paul Raczeck
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Philippe Jagoda
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Christian Schlueter
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Jonas Stroeder
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
| | - Peter Minko
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Centre, Homburg/Saar, Germany
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Abstract
Type 2 endoleaks are the most common endoleak type following endovascular aneurysm repair. The natural history of these endoleaks can vary, with some demonstrating a self-limited or indolent course, while others can contribute to aneurysm sac enlargement and rupture. A variety of embolization techniques, including transarterial catheterization and direct sac puncture techniques, have been developed for the treatment of type 2 endoleaks. In this article, the authors review the indications, techniques, and outcomes of current treatment strategies for type 2 endoleaks.
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Affiliation(s)
- James X Chen
- Division of Vascular and Interventional Radiology Specialists of Charlotte Radiology, Charlotte, North Carolina
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Velocities of type II endoleaks on Doppler ultrasonography predict outcome. J Vasc Surg 2019; 71:1719-1725. [PMID: 31619352 DOI: 10.1016/j.jvs.2019.07.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/18/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to determine whether flow velocities measured using Doppler ultrasonography after endovascular aortic aneurysm repair (EVAR) can predict for resolution of type II endoleaks without intervention. We also assessed the relationship of the flow velocities to sac growth and the need for intervention. We hypothesized that hemodynamic properties suggesting low flow velocity would predict for resolution of type II endoleaks. METHODS The data from 23 patients with type II endoleaks identified on Doppler ultrasonography after EVAR from January 2014 to December 2017 were retrospectively analyzed. The 23 patients with type II endoleaks were split into two groups. Group 1 included the 13 patients with resolved endoleaks or shrinking sac size and group 2, the 10 patients with an increasing sac size or those requiring intervention to seal the endoleak because of an increased sac size. We analyzed the velocities of the endoleak nidus. RESULTS Doppler ultrasound velocities were significantly lower in patients with resolved type II endoleaks and those with a shrinking aneurysm sac size compared with those demonstrating an increase in aneurysm sac size (42.6 ± 25.2 cm/s vs 219.5 ± 84.1 cm/s; P < .0001). Of the 10 patients in group 2, nine had required intervention with either translumbar embolization or transarterial embolization, with only two experiencing complete resolution of the type II endoleak, despite the intervention. All patients in group 2 had had ≥1 duplex ultrasound scan with endoleak nidus velocities >100 cm/s. In contrast, no patient in group 1 had had any duplex ultrasound scan with endoleak nidus velocities >100 cm/s. CONCLUSIONS The Doppler ultrasound velocities of type II endoleaks might be able to predict for spontaneous resolution of type II endoleaks or increased sac growth. Type II endoleaks on Doppler ultrasonography with endoleak nidus velocities >100 cm/s can persistent, even with attempted treatment.
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Harky A, Zywicka E, Santoro G, Jullian L, Joshi M, Dimitri S. Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis. J Ultrasound 2019; 22:65-75. [PMID: 30771104 DOI: 10.1007/s40477-019-00364-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to assess the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) compared to computed tomography angiography (CTA) for the detection of endoleaks within endovascular aortic aneurysm repair (EVAR) surveillance at time of follow up. METHODS A comprehensive literature search was undertaken among the four major databases (PubMed, Embase, Scopus and Ovid) to identify all articles assessing diagnostic specificity and accuracy with comparative modality (CEUS vs CTA) for endoleaks in adult patients at time of follow-up following EVAR. Databases where evaluated and assessed to October 2018. RESULTS A total of 1773 patients were analysed from across 18 included studies in the quantitative analysis of the parameters of interest. There was no significant difference in detection rate of endoleak type I with detection rate 4.3% for both groups OR 1.09, 95% CI [0.78, 1.53], p = 0.62; type II endoleak detection rate was 22% in the CEUS group vs 23% in the CTA group OR 1.16, 95% CI [0.75-1.79], p = 0.50; while type III detection rate was 1.8% in CEUS group vs 2% in CTA group OR 0.85, 95% CI [0.43, 1.68], p = 0.64. However, the sensitivity rate for endoleak detection was higher in CEUS (p = 0.001) while no difference in specificity rate was noted (p = 0.28). There was higher rate of missed endoleaks in CTA groups (n = 12 vs n = 20). CONCLUSION Evidences from this study suggest that contrast-enhanced ultrasound scan post-EVAR can be utilised as safe and effective method in screening for endoleaks during post-EVAR surveillance without exposing the patient for additional risk of radiation and contrast. CEUS conveys no inferiority to CTA in detecting endoleaks.
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Affiliation(s)
- Amer Harky
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK.
| | - Ewa Zywicka
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK
| | - Giovanni Santoro
- Department of General Surgery, Warrington and Halton NHS Foundation Trust, Warrington, WA5 1QG, UK
| | - Lucas Jullian
- Department of Cardiac Surgery, Barts Heart Centre, London, EC1A 7BE, UK
| | - Mihika Joshi
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK
| | - Sameh Dimitri
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK
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A Narrative Review on Contrast-Enhanced Ultrasound in Aortic Endograft Endoleak Surveillance. Ultrasound Q 2019; 34:170-175. [PMID: 29596299 DOI: 10.1097/ruq.0000000000000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms have been performed successfully since 1991. However, 20% to 50% of these patients may develop an endoleak or continued aneurysmal sac expansion or perfusion despite stent graft coverage. Current recommendations suggest lifelong surveillance with computed tomographic angiography (CTA) at least 1 month after intervention and yearly after that. In select patients with a stable aneurysm sac on computed tomography performed 1 year after treatment, future screening could be performed with ultrasonography. However, color Doppler ultrasound can fail to detect as many as 31% of endoleaks. Contrast-enhanced ultrasound (CEUS) provides an alternative approach to excluded aneurysm sac follow-up imaging. The Society for Vascular Surgery notes a need for further research on the role of CEUS in endovascular aortic repair surveillance. The European Federation of Societies for Ultrasound in Medicine and Biology suggests that early results are promising. Meta-analyses report pooled sensitivities and specificities of CEUS compared with CTA for the detection of endoleak between 89% and 98% and 86% and 88%, respectively. Owing to the dynamic flow information it provides, CEUS may actually be more sensitive than CTA at detection and characterization in select circumstances. Challenges with adoption, patient selection, and operator dependency remain, but current and future research suggests a role for CEUS in endoleak surveillance.
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Kapetanios D, Kontopodis N, Mavridis D, McWilliams RG, Giannoukas AD, Antoniou GA. Meta-analysis of the accuracy of contrast-enhanced ultrasound for the detection of endoleak after endovascular aneurysm repair. J Vasc Surg 2019; 69:280-294.e6. [DOI: 10.1016/j.jvs.2018.07.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
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Amin S, Schnabel J, Eldergash O, Chavan A. [Endovascular aneurysm repair (EVAR) : Complication management]. Radiologe 2018; 58:841-849. [PMID: 30083939 DOI: 10.1007/s00117-018-0437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A variety of complications may be experienced during or after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). Acute procedure-related complications include injury to the access vessels, improper endograft placement, ischaemic and systemic complications as well as the postimplantation syndrome. Femoral pseudoaneurysms, endograft migration, kinking or occlusion, endoleaks and endograft infection are complications that have been observed at follow-up. Meticulous patient selection and preprocedural work-up can reduce the incidence of these complications. The majority of the complications, acute as well those at follow-up, can be dealt with endoluminally. It is of essence, however, that a wide variety of catheters, guidewires, stents, stent-grafts and embolics are readily available in the repertoire of the interventionalist. In a small number of patients with endograft occlusion or infection or with bleeding complications/pseudoaneurysms of the access vessels, open surgical intervention may become necessary. To obtain optimal results, close interdisciplinary co-operation, especially between the interventionist, the vascular surgeon and the anaesthetist is mandatory.
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Affiliation(s)
- S Amin
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - J Schnabel
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - O Eldergash
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - A Chavan
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland.
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Monastiriotis S, Lau I, Loh S, Ferretti J, Tassiopoulos A, Labropoulos N. Evolution of type II endoleaks based on different ultrasound-identified patterns. J Vasc Surg 2018; 67:1074-1081. [DOI: 10.1016/j.jvs.2017.08.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/13/2017] [Indexed: 11/16/2022]
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Schnitzbauer M, Güntner O, Wohlgemuth WA, Zeman F, Haimerl M, Stroszczynski C, Müller-Wille R. CT after Endovascular Repair of Abdominal Aortic Aneurysms: Diagnostic Accuracy of Diameter Measurements for the Detection of Aneurysm Sac Enlargement. J Vasc Interv Radiol 2018; 29:178-187.e3. [DOI: 10.1016/j.jvir.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022] Open
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Nolz R, Ulrika A, Furtner J, Woitek R, Unterhumer S, Wibmer A, Prusa A, Loewe C, Schoder M. Type 2 Endoleaks: The Diagnostic Performance of Non-Specialized Readers on Arterial and Venous Phase Multi-Slice CT Angiography. PLoS One 2016; 11:e0149725. [PMID: 26930490 PMCID: PMC4773111 DOI: 10.1371/journal.pone.0149725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/04/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To define the diagnostic precision of non-specialized readers in the detection of type 2 endoleaks (T2EL) in arterial versus venous phase acquisitions, and to evaluate an approach for radiation dose reduction. Methods The pre-discharge and final follow-up multi-slice CT angiographies of 167 patients were retrospectively analyzed. Image data were separated into an arterial and a venous phase reading set. Two radiology residents assessed the reading sets for the presence of a T2EL, feeding vessels, and aneurysm sac size. Findings were compared with a standard of reference established by two experts in interventional radiology. The effective dose was calculated. Results Overall, experts detected 131 T2ELs, and 331 feeding vessels in 334 examinations. Persistent T2ELs causing aneurysm sac growth > 5 mm were detected in 20 patients. Radiation in arterial and venous phases contributed to a mean of 58.6% and 39.0% of the total effective dose. Findings of reader 1 and 2 showed comparable sensitivities in arterial sets of 80.9 versus 85.5 (p = 0.09), and in venous sets of 73.3 versus 79.4 (p = 0.15), respectively. Reader 1 and 2 achieved a significant higher detection rate of feeding vessels with arterial compared to venous set (p = 0.04, p < 0.01). Both readers correctly identified T2ELs with growing aneurysm sac in all cases, independent of the acquisition phase. Conclusion Arterial acquisitions enable non-specialized readers an accurate detection of T2ELs, and a significant better identification of feeding vessels. Based on our results, it seems reasonable to eliminate venous phase acquisitions.
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Affiliation(s)
- Richard Nolz
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Vienna, Austria
- * E-mail:
| | - Asenbaum Ulrika
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of General Radiology, Vienna, Austria
| | - Julia Furtner
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Vienna, Austria
| | - Ramona Woitek
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of General Radiology, Vienna, Austria
| | - Sylvia Unterhumer
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Vienna, Austria
| | - Andreas Wibmer
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Vienna, Austria
| | - Alexander Prusa
- Medical University of Vienna, Department of Surgery, Division of Vascular Surgery, Vienna, Austria
| | - Christian Loewe
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Vienna, Austria
| | - Maria Schoder
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Vienna, Austria
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Cassagnes L, Pérignon R, Amokrane F, Petermann A, Bécaud T, Saint-Lebes B, Chabrot P, Rousseau H, Boyer L. Aortic stent-grafts: Endoleak surveillance. Diagn Interv Imaging 2016; 97:19-27. [DOI: 10.1016/j.diii.2014.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
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Abstract
The management of endoleaks remains an inherent challenge to endovascular aneurysm repair (EVAR), particularly as evolving techniques and devices have allowed treatment of increasingly complex aneurysm anatomy. Endovascular techniques are the favored modality for endoleak repair and include techniques to bridge the endoleak defector and embolize the endoleak nidus and inflow/outflow vessels. Conversion to surgical repair remains the definitive option in cases where less invasive methods have failed or are precluded. In this article, the authors review evidence on the indications, approach, and outcomes of current techniques for endoleak management.
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Affiliation(s)
- James Chen
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Dudeck O, Schnapauff D, Herzog L, Löwenthal D, Bulla K, Bulla B, Halloul Z, Meyer F, Pech M, Gebauer B, Ricke J. Can early computed tomography angiography after endovascular aortic aneurysm repair predict the need for reintervention in patients with type II endoleak? Cardiovasc Intervent Radiol 2014; 38:45-52. [PMID: 24809755 DOI: 10.1007/s00270-014-0901-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was designed to identify parameters on CT angiography (CTA) of type II endoleaks following endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), which can be used to predict the subsequent need for reinterventions. METHODS We retrospectively identified 62 patients with type II endoleak who underwent early CTA in mean 3.7 ± 1.9 days after EVAR. On the basis of follow-up examinations (mean follow-up period 911 days; range, 373-1,987 days), patients were stratified into two groups: those who did (n = 18) and those who did not (n = 44) require reintervention. CTA characteristics, such as AAA, endoleak, as well as nidus dimensions, patency of the inferior mesenteric artery, number of aortic branch vessels, and the pattern of endoleak appearance, were recorded and correlated with the clinical outcome. RESULTS Univariate and receiver operating characteristic curve regression analyses revealed significant differences between the two groups for the endoleak volume (surveillance group: 1391.6 ± 1427.9 mm(3); reintervention group: 3227.7 ± 2693.8 mm(3); cutoff value of 2,386 mm(3); p = 0.002), the endoleak diameter (13.6 ± 4.3 mm compared with 25.9 ± 9.6 mm; cutoff value of 19 mm; p < 0.0001), the number of aortic branch vessels (2.9 ± 1.2 compared with 4.2 ± 1.4 vessels; p = 0.001), as well as a "complex type" endoleak pattern (13.6 %, n = 6 compared with 44.4 %, n = 8; p = 0.02). CONCLUSIONS Early CTA can predict the future need for reintervention in patients with type II endoleak. Therefore, treatment decision should be based not only on aneurysm enlargement alone but also on other imaging characteristics.
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Affiliation(s)
- O Dudeck
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany,
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Khaja MS, Park AW, Swee W, Evans AJ, Fritz Angle J, Turba UC, Sabri SS, Matsumoto AH. Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up. Cardiovasc Intervent Radiol 2013; 37:613-22. [DOI: 10.1007/s00270-013-0706-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
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Gilabert R, Buñesch L, Real MI, García-Criado Á, Burrel M, Ayuso JR, Barrufet M, Montaña X, Riambau V. Evaluation of Abdominal Aortic Aneurysm after Endovascular Repair: Prospective Validation of Contrast-enhanced US with a Second-Generation US Contrast Agent. Radiology 2012; 264:269-77. [DOI: 10.1148/radiol.12111528] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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van den Berg JC. Commentary: Type II endoleaks: still the crux of EVAR? J Endovasc Ther 2012; 19:209-12. [PMID: 22545886 DOI: 10.1583/11-3653c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano sede Civico, Lugano, Switzerland.
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Georgakarakos E, Georgiadis GS, Ioannou CV, Kapoulas KC, Trellopoulos G, Lazarides M. Aneurysm sac shrinkage after endovascular treatment of the aorta: Beyond sac pressure and endoleaks. Vasc Med 2012; 17:168-73. [DOI: 10.1177/1358863x11431293] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The isolation of the aneurysm sac from systemic pressure and its consequent shrinkage are considered criteria of success after endovascular repair (EVAR). However, the process of shrinkage does not solely depend on the intrasac pressure, the predictive role of which remains ambiguous. This brief review summarizes the additional pathophysiological mechanisms that regulate the biomechanical properties of the aneurysm wall and may interfere with the process of aneurysm sac shrinkage.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos V Ioannou
- Department of Vascular Surgery, University of Crete Medical School, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos C Kapoulas
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George Trellopoulos
- First Surgical Clinic, General Hospital ‘G. Papanikolaou’, Exohi, Thessaloniki, Greece
| | - Miltos Lazarides
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Clevert DA, Helck A, D’Anastasi M, Trumm C, Meimarakis G, Weidenhagen R, Kopp R, Jauch K, Reiser M. Ultraschallgesteuerte EVAR-Interventionen und Follow-up-Diagnostik mit der kontrastmittelgestützten Sonographie und der Bildfusion. GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00772-011-0892-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair. J Vasc Surg 2011; 54:947-51. [DOI: 10.1016/j.jvs.2011.03.269] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/23/2011] [Accepted: 03/23/2011] [Indexed: 11/22/2022]
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22
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Evaluation of Potential Outcome Predictors in Type II Endoleak: A Retrospective Study With CT Angiography Feature Analysis. AJR Am J Roentgenol 2011; 197:234-40. [DOI: 10.2214/ajr.10.4566] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Aracil Sanus E, Vila i Coll R, Leal J, Fontcuberta J, Riera Vázquez R, Merino Mairal O. Guía de seguimiento no invasivo del tratamiento endovascular del aneurisma de aorta abdominal. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Abstract
The selective use of endovascular devices to repair abdominal aortic aneurysms was introduced in the early 1990s. Although placement of an aortic endograft offers patients a less morbid alternative to surgical repair, this procedure is not without complications. Persistent perfusion of the residual aneurysmal sac via endoleaks may place the patient at risk for aneurysmal enlargement and subsequent rupture. Historically, serial computed tomographic angiography has been used as the primary modality for assessment of aortic endografts. In recent years, sonography has been shown to provide a valued tool for ongoing surveillance of aortic endografts and identification of endoleaks, increasing aneurysmal size, hemodynamic disorders, and graft migration and/or kinking. Standardization of the sonographic evaluation yields accurate information vital to the long-term patency of these conduits.
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Clevert DA, Horng A, Kopp R, Schick K, Meimarakis G, Sommer WH, Reiser M. [Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS)]. Radiologe 2010; 49:1033-9. [PMID: 19855950 DOI: 10.1007/s00117-009-1876-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue allows a rapid and non-invasive diagnosis in the follow-up after EVAR. The sensitivity and specificity of conventional ultrasound compared to the multislice CT angiography is estimated to be 33-63% and 63-93%, respectively. These values can be increased through the use of CEUS in up to 98-100% (sensitivity) and 82-93% (specificity). This article describes the etiology, classification and importance of different types of endoleaks. The value of CEUS in this clinical scenario will be discussed.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Abstract
Abnormalities of the abdominal aorta and the visceral vessels can represent a diagnostic challenge in patients with both acute and chronic clinical symptoms. In addition to the primary conventional examination using color-coded duplex ultrasound, contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) may contribute to achieving a precise diagnosis. CEUS is a new and promising method in the diagnosis and follow-up of aortic and visceral artery lesions. Color-coded duplex ultrasound and CEUS with SonoVue(R) allow a rapid and non-invasive diagnosis especially in critically ill patients as these methods can readily be applied at the bedside. In this article the contribution of color-coded duplex ultrasound and CEUS as compared to multi-slice computed tomography angiography (MS-CTA) in various pathologies of the abdominal aorta and the visceral arteries will be addressed.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Endoleaks after endovascular repair of abdominal aortic aneurysm: value of CEUS. ACTA ACUST UNITED AC 2009; 35:106-14. [DOI: 10.1007/s00261-009-9526-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 04/19/2009] [Indexed: 11/26/2022]
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Iezzi R, Basilico R, Giancristofaro D, Pascali D, Cotroneo AR, Storto ML. Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2009; 49:552-60. [DOI: 10.1016/j.jvs.2008.10.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/30/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
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Surveillance des endoprothèses aortiques abdominales : intérêt de l’échographie-doppler standard et avec contraste. ACTA ACUST UNITED AC 2009; 34:34-43. [DOI: 10.1016/j.jmv.2008.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 10/08/2008] [Indexed: 11/17/2022]
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Deklunder G, Sediri I, Donati T, Boivin V, Gautier C, Haulon S. Intérêt de l’échographie de contraste dans la surveillance des endoprothèses aortiques. ACTA ACUST UNITED AC 2009; 90:141-7. [DOI: 10.1016/s0221-0363(09)70092-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carrafiello G, Recaldini C, Laganà D, Piffaretti G, Fugazzola C. Endoleak detection and classification after endovascular treatment of abdominal aortic aneurysm: value of CEUS over CTA. ACTA ACUST UNITED AC 2008; 33:357-62. [PMID: 17619925 DOI: 10.1007/s00261-007-9268-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper focuses on the diagnostic value of CEUS in the detection and characterization of endoleaks in comparison with other imaging modalities, primary CDUS and CTA in the follow-up of endovascular abdominal aortic aneurysm repair. CEUS is an interesting alternative technique because of its limited costs and lack of exposure to ionizing radiation. However, CTA cannot currently be substituted because it enables a more precise evaluation of aneurysm morphologic changes, aneurysm sac diameter, graft anchorage and integrity. CEUS could be used along with CTA when the latter reveals the presence of endoleak, to provide a better characterization of it taking advantage of the angiodynamic behavior of the contrast agent that permits an easier visualization of the agent flow into the sac. It could also be indicated when aneurysm diameter increases and CTA did not show sac reperfusion or to monitor type II endoleaks reducing the use of CTA with consequent reduction of costs and exposure to radiation.
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Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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Clevert DA, Stickel M, Johnson T, Glaser C, Clevert DA, Steitz HO, Kopp R, Jauch KW, Reiser M. Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 2007; 17:2991-3000. [PMID: 17219146 DOI: 10.1007/s00330-006-0542-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 10/25/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
Aortic abnormalities are commonly encountered and may represent a diagnostic challenge in patients with acute or chronic clinical symptoms. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a new promising method in the diagnosis and follow-up of pathological aortic lesions. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients because of its bedside availability. This review compares CEUS findings with those documented on computed tomography angiography (CTA), allowing the reader to appreciate the usefulness of CEUS in this clinical situation.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern, Munich, Germany.
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Higashiura W, Greenberg RK, Katz E, Geiger L, Bathurst S. Predictive Factors, Morphologic Effects, and Proposed Treatment Paradigm for Type II Endoleaks after Repair of Infrarenal Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2007; 18:975-81. [PMID: 17675614 DOI: 10.1016/j.jvir.2007.05.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the predictive factors and outcome of type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms with use of a Zenith endograft. MATERIALS AND METHODS Patients classified at high risk were enrolled in a prospective study and evaluated with serial cross-sectional imaging techniques. The effect of a type II endoleak on sac behavior and associated factors were analyzed. Type II endoleaks were categorized as absent, persistent, or transient, and the morphologic effects were determined. Logistic regression and classification tree were used to predict which patients may be at risk for persistent type II endoleaks. RESULTS A total of 273 patients were enrolled. Patients were excluded in the absence of a minimum of 6 months digital data or the presence of endoleak not classified as type II. Two hundred four patients met inclusion criteria, with a median follow-up period of 24 months (range, 6-60 months). Early type II endoleak was detected in 35 patients (17%), which resolved spontaneously in 17 cases. There were 18 patients with persistent endoleak, 17 patients with transient type II endoleak, and 169 patients with no endoleak. Aneurysm enlargement was detected in seven patients with persistent endoleak (39%), no patients with transient type II endoleak, and one patient with no endoleak. No variables were predictive of the development of persistent endoleak. The relative risk of aneurysmal growth was 77 with persistent endoleak. Successfully treated persistent endoleaks were not associated with any growth. CONCLUSIONS Persistent endoleaks are associated with sac growth. Transient type II endoleaks have a benign course and do not require treatment. Successful treatment of persistent endoleak ameliorates the risk of growth.
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Affiliation(s)
- Wataru Higashiura
- Department of Vascular Surgery, Cleveland Clinic Hospital Systems, Cleveland, Ohio 44195, USA
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Stavropoulos SW, Charagundla SR. Imaging Techniques for Detection and Management of Endoleaks after Endovascular Aortic Aneurysm Repair1. Radiology 2007; 243:641-55. [PMID: 17517926 DOI: 10.1148/radiol.2433051649] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endovascular aortic aneurysm repair (EVAR) is evolving into a viable alternative to open surgical repair for many patients with abdominal and thoracic aortic aneurysms. Endoleak development is a complication of EVAR and represents one of the limitations of this procedure. Endoleaks represent blood flow outside the stent-graft lumen but within the aneurysm sac. Lifelong imaging surveillance of patients after EVAR is critical to detect endoleaks for the patient's benefit and to determine the long-term performance of the stent-graft. Although computed tomographic angiography is the most commonly used examination for imaging surveillance, magnetic resonance angiography, ultrasonography, and digital subtraction angiography all have a role in endoleak detection and management. This review will focus on imaging techniques used for endoleak detection and the role imaging surveillance plays in the overall care of the post-EVAR patient.
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Affiliation(s)
- S William Stavropoulos
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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Carrafiello G, Laganà D, Recaldini C, Mangini M, Bertolotti E, Caronno R, Tozzi M, Piffaretti G, Genovese EA, Fugazzola C. Comparison of Contrast-Enhanced Ultrasound and Computed Tomography in Classifying Endoleaks After Endovascular Treatment of Abdominal Aorta Aneurysms: Preliminary Experience. Cardiovasc Intervent Radiol 2006; 29:969-74. [PMID: 16897267 DOI: 10.1007/s00270-005-0267-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of the study was to assess the effectiveness of contrast-enhanced ultrasonography (CEUS) in endoleak classification after endovascular treatment of an abdominal aortic aneurysm compared to computed tomography angiography (CTA). From May 2001 to April 2003, 10 patients with endoleaks already detected by CTA underwent CEUS with Sonovue to confirm the CTA classification or to reclassify the endoleak. In three conflicting cases, the patients were also studied with conventional angiography. CEUS confirmed the CTA classification in seven cases (type II endoleaks). Two CTA type III endoleaks were classified as type II using CEUS and one CTA type II endoleak was classified as type I by CEUS. Regarding the cases with discordant classification, conventional angiography confirmed the ultrasound classification. Additionally, CEUS documented the origin of type II endoleaks in all cases. After CEUS reclassification of endoleaks, a significant change in patient management occurred in three cases. CEUS allows a better attribution of the origin of the endoleak, as it shows the flow in real time. CEUS is more specific than CTA in endoleak classification and gives more accurate information in therapeutic planning.
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Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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Abstract
Frequent and sustained surveillance continues to be mandated for all patients who undergo endovascular repair of the aneurysmal aorta in order to minimize the small but attendant risk of aneurysm rupture. The primary motivation for surveillance includes evaluation of residual aneurysm sac size and presence of endoleak, as well as potential adverse device specific events, such as endograft migration, module disconnection, or component fatigue and failure. The current standard of care and future surveillance modalities after endovascular repair of both abdominal aortic and thoracic aortic aneurysms will be reviewed.
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Affiliation(s)
- Ross Milner
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Henao EA, Hodge MD, Felkai DD, McCollum CH, Noon GP, Lin PH, Lumsden AB, Bush RL. Contrast-enhanced Duplex surveillance after endovascular abdominal aortic aneurysm repair: Improved efficacy using a continuous infusion technique. J Vasc Surg 2006; 43:259-64; discussion 264. [PMID: 16476596 DOI: 10.1016/j.jvs.2005.09.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 09/26/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Currently, postoperative endoleak surveillance after endovascular aortic aneurysm repair (EVAR) is primarily done by computed tomography (CT). The purpose of this study was to determine the efficacy of contrast-enhanced ultrasonography scans to detect endoleaks by using a novel infusion method and compare these findings with those of CT angiography (CTA). METHODS Twenty male patients (mean age, 70.4 years) underwent surveillance utilizing both CTA and contrast-enhanced color Duplex imaging. One 3-mL vial of Optison (Perfluten Protein A microspheres for injection) and 57 mL normal saline, for a total of 60 mL, were administered to each patient as a continuous infusion at 4 mL/min via a peripheral vein. Each study was optimized with harmonic imaging, and a reduced mechanical index of 0.4 to 0.5, compression of 1 to 3, and a focal zone below the aorta to minimize microsphere rupture. One minute was allowed from the time of infusion to the appearance of contrast in the endograft. Flow was evaluated within the lumen of the graft and its components, as was the presence or absence of endoleaks. Findings were compared with standard color-flow Duplex imaging and CT utilizing CTA reconstruction protocols. RESULTS All patients evaluated had modular endografts implanted for elective aneurysm repair. Contrast-enhanced duplex scans identified nine endoleaks: one type I and eight type II. No additional endoleaks were seen on CTA. However, CTA failed to recognize three type II endoleaks seen by contrast-enhanced ultrasound. The continuous infusion method allowed for longer and more detailed imaging. An average of 46.8 mL of the contrast infusion solution was used per patient. CONCLUSIONS Contrast enhanced Duplex ultrasonography accurately demonstrates endoleaks after EVAR and may be considered as a primary surveillance modality. Continuous infusion permits longer imaging time.
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