Duplex Ultrasound versus Computed Tomography for the Postoperative Follow-Up of Endovascular Abdominal Aortic Aneurysm Repair. Where Do We Stand Now?

Karanikola, Evridiki; Dalainas, Ilias; Karaolanis, Georgios; Zografos, Georgios; Filis, Konstantinos

doi:10.1055/s-0034-1387925

Cited by 22 publications

(11 citation statements)

References 88 publications

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“…18 A significant increase in aneurysm size, the detection of a new endoleak or cases in which CDU is non-diagnostic because of obesity, gas or the lack of a suitable window, may also prompt further imaging with CTA for clarification. 3,12,36 A survey conducted in 2010 among the 41 clinical centres enrolled in the UK EVAR trial 1 47 showed that 12 out of 41 centres used CTA as the primary surveillance modality, 14 out of 41 centres used CDU as the primary surveillance modality and 15 out of 41 centres used a combination of CTA and CDU. Similarly, the recently published 15-year follow-up of the UK EVAR trial 1 48 demonstrated a shift in contemporary practice towards CDU.…”

Section: Discussionmentioning

confidence: 99%

“…The literature searches for the clinical effectiveness review were sufficiently broad that they retrieved nine relevant diagnostic test accuracy reviews. 3,62,[127][128][129][130][131][132][133] Therefore, specific searching to identify additional reviews was more focused but included appropriate subject headings and text word terms. To combine the search facets for endovascular aneurysm repair, the imaging modalities under consideration and diagnostic reviews, MEDLINE and EMBASE were searched from 1996 until March 2016, whereas the CDSR and DARE were searched on 29 March 2016 without date restrictions.…”

Section: Identification Of Studiesmentioning

confidence: 99%

“…3,62,[127][128][129][130]132,133 The majority of the included reviews were considered to have searched major relevant bibliographic data sources, conducted hand-searching of references and provided example of key text words, 3,62,127,128,130,132 specified their inclusion/exclusion criteria 62,127,128,130,132,133 and provided sufficient information on the characteristics of included studies. 3,62,127,130,132,133 However, only one study provided information on the inclusion of grey literature and on a priori design, 127 two reported on duplicated selection and extraction, 62,127 two provided a list of excluded studies, 130,133 one assessed the presence of publication bias 62 and only two used the results of the risk-of-bias assessment to draw conclusions. 62,132 A potential conflict of interest was assessed in half of the included reviews.…”

Section: Quality Assessment Of the Diagnostic Test Performance Reviewsmentioning

confidence: 99%

“…62,127,130,132 The three remaining reviews were considered to be of moderate quality. 3,128,133 Assessment of diagnostic test performance…”

Section: Quality Assessment Of the Diagnostic Test Performance Reviewsmentioning

confidence: 99%

“…129,132 The systematic review by Ashoke et al 127 provided estimates of accuracy for CDU based on eight published data sources and also combined the results of the published data with two unpublished data sources. The review by Karanikola et al 3 did not combine estimates of test accuracy because of the heterogeneity observed between the included studies.…”

Section: Quality Assessment Of the Diagnostic Test Performance Reviewsmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Identification Of Studiesmentioning

confidence: 99%

Section: Quality Assessment Of the Diagnostic Test Performance Reviewsmentioning

confidence: 99%

“…62,127,130,132 The three remaining reviews were considered to be of moderate quality. 3,128,133 Assessment of diagnostic test performance…”

Section: Quality Assessment Of the Diagnostic Test Performance Reviewsmentioning

confidence: 99%

Section: Quality Assessment Of the Diagnostic Test Performance Reviewsmentioning

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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Abdominal Aortic Aneurysms

Wengerter¹,

Wengerter²,

Marin³

2018

Endovascular Interventions

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Imaging modalities for endoleak surveillance

Williams

2021

J of Medical Radiation Sci

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As the global population ages, the issue of abdominal aortic aneurysm continues to grow. With the evolution of new devices and refined operative technique, aneurysm treatment via endovascular aortic repair is becoming increasingly favourable. This, however, is not without drawbacks, where regular surveillance is paramount to long-term success and detection of post-procedure complications. Of these complications, endoleak is the most notable and poses the greatest risk of potential future aortic rupture. The purpose of this review paper is to discuss the armada of imaging modalities used in the detection and evaluation of endoleak and their varying usefulness. Plain abdominal X-ray is a cost-effective tool in detecting gross graft abnormalities such as stent migration or deformity (kinking or fracture). Though it may raise suspicion for endoleak, X-ray does not allow accurate classification of endoleak type when used alone. Duplex ultrasonography quantifies both aortic anatomy and real time flow dynamics. Most screening programmes are conducted using two-dimensional ultrasound. Unfortunately, observer and equipment variability may lead to surveillance discrepancies-but reduced when utilising a dedicated vascular sonography laboratory. Contrast enhanced ultrasonography is a promising alternative to computed tomography, though still is emerging. Computed tomography angiography certainly has disadvantages (ionising radiation, contrast-nephropathy, limited differentiation of endoleak type)-however, it provides near-real surgical dimensions and highlights graft complications and concomitant disease (such as neighbouring infection). With widespread availability and short scan time, it certainly remains valuable in surveillance. Magnetic resonance angiography has a similar sensitivity to computed tomography (minus the radiation), however is plagued by movement and metal artefact. Other novel modalities in endoleak surveillance include fourdimensional ultrasound, multiplanar intra-operative probes, nuclear medicine and wall stress analysis.

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Duplex Ultrasound versus Computed Tomography for the Postoperative Follow-Up of Endovascular Abdominal Aortic Aneurysm Repair. Where Do We Stand Now?

Cited by 22 publications

References 88 publications

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

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

Abdominal Aortic Aneurysms

Imaging modalities for endoleak surveillance

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