Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: Can we simplify the surveillance protocol and reduce the number of CT scans?

Nyheim, Thomas; Staxrud, L.E.; Rosén, L.; Slagsvold, Carl-Erik; Sandbæk, Gunnar; Jørgensen, Jørgen J.

doi:10.1258/ar.2012.110291

Cited by 15 publications

(41 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…65 The four italicised questions of the checklist used to evaluate the risk of bias of comparative studies were disregarded for all but the two included comparative studies. 66,67 Individual items within the checklist were rated as 'yes ', 'no' or 'unclear' so that a rating of 'yes' denoted the optimal rating for methodological quality. We did not assess the quality of abstracts, as the word limit for abstracts is usually insufficient to make informed judgements about the potential risk of bias of the reported study.…”

Section: Quality Assessment Strategymentioning

confidence: 99%

“…The results of the methodological quality assessment for the two non-randomised comparative cohort studies 66,67 indicated that the Chisci et al 66 study was of moderate methodological quality, whereas the Nyheim et al 67 study was of poor methodological quality, mainly because over half of the ReBIP checklist items were rated as having an 'unclear' risk of bias. 67 In particular, it was unclear if the patients were taken from a representative sampleat a similar point in their disease progressionor selected consecutively, and if the study groups were comparable. 67 The study groups in the Chisci et al 66 study were comparable, but we noted that the length of the follow-up period was not similar between the study groups.…”

Section: Non-randomised Comparative Cohort Studiesmentioning

confidence: 99%

“…67 In particular, it was unclear if the patients were taken from a representative sampleat a similar point in their disease progressionor selected consecutively, and if the study groups were comparable. 67 The study groups in the Chisci et al 66 study were comparable, but we noted that the length of the follow-up period was not similar between the study groups. In both studies, it was unclear whether or not the outcomes were assessed blindly or if the authors had adjusted for confounding factors.…”

Section: Non-randomised Comparative Cohort Studiesmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Quality Assessment Strategymentioning

confidence: 99%

Section: Non-randomised Comparative Cohort Studiesmentioning

confidence: 99%

Section: Non-randomised Comparative Cohort Studiesmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Both grayscale and Doppler techniques have been described in the literature, with aortic diameter measurements equivalent, and in one study more precise, than measurements using CTA. 62,63 Similar to TR-MRA, color Doppler ultrasound can reveal the directionality of endoleak because of its sensitivity for flowing blood. 62 Spectral Doppler allows the analysis of waveforms within regions of endoleak to document arterial inflow.…”

Section: Ultrasoundmentioning

confidence: 99%

“…62,63 Similar to TR-MRA, color Doppler ultrasound can reveal the directionality of endoleak because of its sensitivity for flowing blood. 62 Spectral Doppler allows the analysis of waveforms within regions of endoleak to document arterial inflow. Contrastenhanced ultrasound (CEUS) using nontargeted microbubbles can offer supplementation to CTA or unenhanced ultrasound in a problem-solving role.…”

Section: Ultrasoundmentioning

confidence: 99%

Surveillance Imaging Following Endovascular Aneurysm Repair

Pandey

Litt

2015

Semin intervent Radiol

View full text Add to dashboard Cite

There is a significant risk of complication following endovascular abdominal repair (EVAR), including endoleak, graft translocation, thrombosis, and infection. Surveillance imaging is important for detecting EVAR complication. Surveillance modalities include conventional X-ray, computed tomography, magnetic resonance imaging, ultrasound, and conventional angiography, with inherent advantages and drawbacks to each modality. The authors present common complications following EVAR, and recent advances in the key modalities for surveillance.

show abstract

Ultrasonography for endoleak detection after endoluminal abdominal aortic aneurysm repair

Abraha¹,

Luchetta

Florio³

et al. 2017

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background People with abdominal aortic aneurysm who receive endovascular aneurysm repair (EVAR) need lifetime surveillance to detect potential endoleaks. Endoleak is defined as persistent blood flow within the aneurysm sac following EVAR. Computed tomography (CT) angiography is considered the reference standard for endoleak surveillance. Colour duplex ultrasound (CDUS) and contrast-enhanced CDUS (CE-CDUS) are less invasive but considered less accurate than CT. Objectives To determine the diagnostic accuracy of colour duplex ultrasound (CDUS) and contrast-enhanced-colour duplex ultrasound (CE-CDUS) in terms of sensitivity and specificity for endoleak detection after endoluminal abdominal aortic aneurysm repair (EVAR). Search methods We searched MEDLINE, Embase, LILACS, ISI Conference Proceedings, Zetoc, and trial registries in June 2016 without language restrictions and without use of filters to maximize sensitivity. Selection criteria Any cross-sectional diagnostic study evaluating participants who received EVAR by both ultrasound (with or without contrast) and CT scan assessed at regular intervals. Data collection and analysis Two pairs of review authors independently extracted data and assessed quality of included studies using the QUADAS 1 tool. A third review author resolved discrepancies. The unit of analysis was number of participants for the primary analysis and number of scans performed for the secondary analysis. We carried out a meta-analysis to estimate sensitivity and specificity of CDUS or CE-CDUS using a bivariate model. We analysed each index test separately. As potential sources of heterogeneity, we explored year of publication, characteristics of included participants (age and gender), direction of the study (retrospective, prospective), country of origin, number of CDUS operators, and ultrasound manufacturer. Ultrasonography for endoleak detection after endoluminal abdominal aortic aneurysm repair (Review)

show abstract

Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: Can we simplify the surveillance protocol and reduce the number of CT scans?

Abstract: US appears comparable to CT in the follow-up of Talent stent grafts in our institution. The proposed simplified surveillance protocol seems safe and can lead to a significant reduction in the number of CT scans.

Cited by 15 publications

References 26 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

Surveillance Imaging Following Endovascular Aneurysm Repair

Ultrasonography for endoleak detection after endoluminal abdominal aortic aneurysm repair

Contact Info

Product

Resources

About