Continuous Ultrasound Contrast Infusion as an Adjunct to Color Duplex Ultrasound in the Assessment of Aortic Endografts

Abstract

Objective —We sought to evaluate continuous ultrasound contrast infusion Optison® as an adjunct to color duplex ultrasound (CDU) in endoleak detection. Methods —Endoleak surveillance, including CDU, Optison®, and computed tomography (CTA), was performed during 18 examinations. One (3 ml) vial of Optison® was diluted in a 57-ml syringe of normal saline (total 60 ml) and administered by infusion pump at 4 ml/hr. Transverse and sagittal views were performed of the aortic aneurysm sac, endograft, and arteries outside the aneurysm sac. Primary endpoints were endograft patency, the presence or absence of endoleak, and limb dysfunction. Results —There were no adverse events related to the contrast agent. Contrast appearance through the endograft occurred after an average of 1 min using a mean of 46.8 ml of contrast infusion per patient. There were 10 enodleaks clearly identified by CDU and Optison®, i.e., 2 type I, 4 type II, and 2 type III endoleaks with an additional study suspicious for endoleak. Using CDU and CTA, we found 9 studies without endoleaks whereas with Optison®, we found 8 studies normal. Comparatively, when using CTA, we identified only 2 definitive endoleaks. Of the 9 endoleaks identified by using CDU and Optison®, 2 of the endoleaks were type I and not observed on conventional CTA and were later confirmed by arteriogram. One study was deemed negative by CDU and Optison® whereas CTA results were suspicious. Body habitus was prohibitive for definitive CDU findings in one patient. Conclusions —Using continuous ultrasound contrast infusion as an adjunct to CDU allowed for longer imaging time and more extensive evaluation of the endograft, the aneurysm sac, and the perianeurysmal arteries in these patients. Our early results demonstrate that the use of ultrasound contrast for endoleak detection is reliable and may be considered a primary surveillance modality after endovascular aortic aneurysm repair.

Sonographic Evaluation of Aortic Endografts

“…In some centers, contrast-enhanced studies have become the standard for endoleak identification. [13][14][15][16][17][18][19]…”

Spontaneous Regression of a Type I Endoleak Documented with Duplex Ultrasound

“…The success of minimally invasive endovascular aortic aneurysm repair (EVAR) has helped drastically reduce the need for open repair of abdominal aortic aneurysms (AAAs). 1 This success has resulted in a significant increase in the number of EVARs performed in the United States. 2 Although EVAR represents a major advance in the management of aortic aneurysm disease, it comes with a price: the increased risk of postoperative (usually late) complications, 3 which mandates vigilant postoperative surveillance protocols using computed tomographic (CT), intraaortic sac pressure measurement or duplex ultrasound technology (DU).…”