Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device

Blom, Aaron S.; Troutman, Douglas A.; Beeman, Brian; Yarchoan, Mark; Dougherty, Matthew J.; Calligaro, Keith D.

doi:10.1016/j.jvs.2011.12.058

Cited by 15 publications

(22 citation statements)

References 23 publications

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“…Of the 17 graft limbs with PSV>300 cm/s, seven developed occlusion and five underwent a prophylactic intervention. The remaining five remained patent over a mean 46 month follow up [5]. We concluded that limb velocities of PSV<300 cm/s and PSV ratio of <3.5 predict for longterm graft limb patency, but they should have continued surveillance.…”

Section: Descriptionmentioning

confidence: 82%

Duplex Ultrasonography and its Use in Surveillance Post-EVAR

Pineda¹,

Dougherty²,

Calligaro³

et al. 2015

J Vasc Med Surg

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After endovascular aortic aneurysm repair (EVAR), patients require annual surveillance with either CT scan or duplex ultrasonography (DU). These studies should be used to identify patients who require reintervention for EVAR complications. DU, a less expensive and radiation free option, has been shown to accurately predict aneurysm sac size and endoleak. In addition, using criteria of PSV<300 cm/s and PSV ratio <3.5, DU can rule out limb stenosis. After a normal post-procedure DU, only 2.2% of patients require reintervention within the first 3 years suggesting that less frequent follow-up may be utilized. DU is an important tool in the surveillance of EVAR patients.

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Section: Descriptionmentioning

confidence: 82%

Duplex Ultrasonography and its Use in Surveillance Post-EVAR

Pineda¹,

Dougherty²,

Calligaro³

et al. 2015

J Vasc Med Surg

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“…The 22 cohort studies published in full were of mixed quality (Figure 3). 40,41,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] The individual study-level results are detailed in Appendix 6. For the majority of studies, over half or more of the ReBIP criteria were not met, or the information provided in the studies was insufficient to determine if the criteria were met, and were, therefore, judged as being of low or moderate quality.…”

Section: Cohort Studiesmentioning

confidence: 99%

“…Information was not available from six studies. 69,71,78,81,82,89 b Per cent of total studies that provided data. Seven studies did not provide data.…”

Section: Study Characteristics Of All Included Studiesmentioning

confidence: 99%

“…[69][70][71]73,81,87,89 c Information not available from 15 trials. 41,67,69,[71][72][73][74]79,80,82,84,[88][89][90] d Per cent of total studies that provided data. Information was not available from 14 studies.…”

Section: Study Characteristics Of All Included Studiesmentioning

confidence: 99%

“…Information was not available from 14 studies. 41,67,69,[71][72][73]78,[81][82][83]86,[88][89][90] e Includes congestive heart failure, myocardial infarction, heart disease, coronary heart disease, hypercholesterolaemia, coronary artery bypass. f Includes chronic obstructive pulmonary disease.…”

Section: Study Characteristics Of All Included Studiesmentioning

confidence: 99%

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Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation

Brazzelli

Hernández

Sharma

et al. 2018

Health Technol Assess

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Background Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important complications. Patients receiving EVAR require long-term surveillance to detect abnormalities and direct treatments. Computed tomography angiography (CTA) has been the most common imaging modality adopted for EVAR surveillance, but it is associated with repeated radiation exposure and the risk of contrast-related nephropathy. Colour duplex ultrasound (CDU) and, more recently, contrast-enhanced ultrasound (CEU) have been suggested as possible, safer, alternatives to CTA. Objectives To assess the clinical effectiveness and cost-effectiveness of imaging strategies, using either CDU or CEU alone or in conjunction with plain radiography, compared with CTA for EVAR surveillance. Data sources Major electronic databases were searched, including MEDLINE, EMBASE, Science Citation Index, Scopus’ Articles-in-Press, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database from 1996 onwards. We also searched for relevant ongoing studies and conference proceedings. The final searches were undertaken in September 2016. Methods We conducted a systematic review of randomised controlled trials and cohort studies of patients with AAAs who were receiving surveillance using CTA, CDU and CEU with or without plain radiography. Three reviewers were involved in the study selection, data extraction and risk-of-bias assessment. We developed a Markov model based on five surveillance strategies: (1) annual CTA; (2) annual CDU; (3) annual CEU; (4) CDU together with CTA at 1 year, followed by CDU on an annual basis; and (5) CEU together with CTA at 1 year, followed by CEU on an annual basis. All of these strategies also considered plain radiography on an annual basis. Results We identified two non-randomised comparative studies and 25 cohort studies of interventions, and nine systematic reviews of diagnostic accuracy. Overall, the proportion of patients who required reintervention ranged from 1.1% (mean follow-up of 24 months) to 23.8% (mean follow-up of 32 months). Reintervention was mainly required for patients with thrombosis and types I–III endoleaks. All-cause mortality ranged from 2.7% (mean follow-up of 24 months) to 42% (mean follow-up of 54.8 months). Aneurysm-related mortality occurred in < 1% of the participants. Strategies based on early and mid-term CTA and/or CDU and long-term CDU surveillance were broadly comparable with those based on a combination of CTA and CDU throughout the follow-up period in terms of clinical complications, reinterventions and mortality. The economic evaluation showed that a CDU-based strategy generated lower expected costs and higher quality-adjusted life-year (QALYs) than a CTA-based strategy and has a 63% probability of being cost-effective at a £30,000 willingness-to-pay-per-QALY threshold. A CEU-based strategy generated more QALYs, but at higher costs, and became cost-effective only for high-risk patient groups. Limitations Most studies were rated as being at a high or moderate risk of bias. No studies compared CDU with CEU. Substantial clinical heterogeneity precluded a formal synthesis of results. The economic model was hindered by a lack of suitable data. Conclusions Current surveillance practice is very heterogeneous. CDU may be a safe and cost-effective alternative to CTA, with CTA being reserved for abnormal/inconclusive CDU cases. Future work Research is needed to validate the safety of modified, more-targeted surveillance protocols based on the use of CDU and CEU. The role of radiography for surveillance after EVAR requires clarification. Study registration This study is registered as PROSPERO CRD42016036475. Funding The National Institute for Health Research Health Technology Assessment programme.

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