Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair

Motta, Raffaella; Rubaltelli, Léopoldo; Vezzaro, R.; Vida, Vladimiro L.; Marchesi, P.; Stramare, Roberto; Zanon, Antonio; Battistel, Michele; Sommavilla, Marco; Miotto, Diego

doi:10.1007/s11547-012-0809-x

Cited by 23 publications

(29 citation statements)

References 45 publications

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“…In conclusion, based on advantages of CEUS, some scholars suggest using CEUS as the preferred alternative for follow-up of post-EVAR AAA. [ 8 23 24 ] In addition to the safety and diagnostic accuracy of CEUS, there are still other advantages, such as lower price compared with CTA, and it is portable and convenient for conducting ongoing surveillance of surgery. CEUS provides a new, safe, effective, economic, and noninvasive follow-up method for post-EVAR patients with AAA.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Yang

Chen

Zhang

et al. 2015

Chinese Medical Journal

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Background:Endovascular aneurysm repair (EVAR) is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography (CTA), which is routine for follow-up, has side effects (e.g., radiation) and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound (CEUS) have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak.Methods:Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging (CDFI) and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDFI was conducted using Fisher's exact test and clinical outcomes of all patients were followed up.Results:Sixteen patients were enrolled, and 12 (75%) had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFI-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically different (P = 0.008). Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type III endoleak had open surgery when endovascular repair failed.Conclusions:CEUS is a new, safe, and effective means for detection of endoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Yang

Chen

Zhang

et al. 2015

Chinese Medical Journal

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“…This finding may be interpreted as suggesting that a moderate reduction of the number of CTAs, for example, by switching from yearly to longer intervals after a certain surveillance period or by introducing surveillance protocols where CTA and imaging techniques not involving ionizing radiation are scheduled alternately, may not yield a tremendous benefit with a view to exposure reduction. Alternative methods such as contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI), and implantable wireless aneurysm sac pressure sensors have been investigated and were suggested to be applied in post-EVAR surveillance, but completely banning CTA from post-EVAR follow-ups is currently not generally considered advisable [ 18 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of Factors Influencing Cumulative Long-Term Radiation Exposure in Patients Undergoing EVAR

Kalender

Lisy

Stock

et al. 2017

International Journal of Vascular Medicine

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Patients who undergo endovascular repair of aortic aneurysms (EVAR) require life-long surveillance because complications including, in particular, endoleaks, aneurysm rupture, and graft dislocation are diagnosed in a certain share of the patient population and may occur at any time after the original procedure. Radiation exposure in patients undergoing EVAR and post-EVAR surveillance has been investigated by previous authors. Arriving at realistic exposure data is essential because radiation doses resulting from CT were shown to be not irrelevant. Efforts directed at identification of factors impacting the level of radiation exposure in both the course of the EVAR procedure and post-EVAR endovascular interventions and CTAs are warranted as potentially modifiable factors may offer opportunities to reduce the radiation. In the light of the risks found to be associated with radiation exposure and considering the findings above, those involved in EVAR and post-EVAR surveillance should aim at optimal dose management.

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“…Outer to outer wall measurements are the ones more closely correlated with CT findings ( 52 ). The discrepancy seems to be resolved with 3D CEUS, as numerous studies have demonstrated strong correlation with CTA measurements ( 9 , 36 , 43 , 48 , 52 ).…”

Section: Need For Accredited Labsmentioning

confidence: 97%

“…Additionally, the spatial tracking and 3D reconstruction afforded by a 3D system allows for greater reproducibility and decreases operator dependency and intraobserver variability as well as provides a greater field of resolution ( 11 , 34 ). CEUS has been found equivalent to CTA in endoleak detection in a number of studies with many authors going so far as to advocate the replacement of CTA with CEUS in the post-procedural surveillance of an aneurysm and detection of endoleaks ( 34 , 38 , 41 – 43 ). In the postoperative evaluation of novel grafts, such as fenestrated endovascular aneurysm grafts, 4D CEUS was found equivalent to CTA in assessing diameter, volume, endoleaks, as well as revascularized vessel patency ( 9 ).…”

Section: Evar Surveillancementioning

confidence: 99%

Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

et al. 2016

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Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy.

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Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair

Cited by 23 publications

References 45 publications

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Identification of Factors Influencing Cumulative Long-Term Radiation Exposure in Patients Undergoing EVAR

Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

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