VASCULAR
REVIEWED BY Heath Edwards ASA SIG: Vascular REFERENCE
Contrast-enhanced ultrasound detects type II endoleaks during follow-up for endovascular aneurysm repair
Authors: L Johnsen, J Hisdal, T Jonung, A Braaten, G Pedersen Journal: J Vasc Surg. 2020;72(6): 1952-1959 Open Access: Yes READ THE FULL ARTICLE HERE
WHY THE STUDY WAS PERFORMED Endovascular aneurysm repair (EVAR) requires lifelong follow-up due to the potential for major complications. Surveillance of EVAR using computed tomography angiography (CTA) leads to increased radiation dose and exposure to nephrotoxic contrast agents. This study was performed to investigate the sensitivity of contrastenhanced ultrasound (CEUS) versus CTA, post EVAR, concerning the detection of an endoleak.
HOW THE STUDY WAS PERFORMED The study included 79 men and 13 women with each patient scheduled for paired CTA and CEUS appointments at 1 month, 6 months, 12 months, and 24 months, post EVAR.
High sensitivity and specificity as well as avoidance of radiation and nephrotoxic contrast agents are advantages.
Altogether, 233 paired CEUS and CTA examinations were performed. Data was missed due to patient limitations: renal failure leading to the inability to perform CTA, inability to be transported for follow-up due to worsening health condition, and patient death. The results from the CEUS were blinded from the operator performing the CTA and vice versa. The results from previous paired examinations in the same patient were also unavailable when a new follow-up examination was being conducted.
WHAT THE STUDY FOUND Of the total 233 paired examinations, CEUS detected 39 of the 48 endoleaks detected on CTA. Two false positives were noted, with the overall sensitivity of CEUS 81.3%. All the endoleaks detected in this study population were type II. The 9 endoleaks missed on CEUS were defined as small type II endoleaks on the CTA reports, with no increase in aneurysm sac or intervention required. Patient body mass index (BMI) was a limiting factor with the false positive rate substantially higher with increased BMI as depicted in the graph below: Although CEUS seems to be able to detect endoleaks with high precision, this study showed that the missed endoleaks on CEUS are overrepresented in the patient group with high BMIs.
RELEVANCE TO CLINICAL PRACTICE High sensitivity and specificity as well as the avoidance of radiation and nephrotoxic contrast agents are advantages of CEUS vs CTA in follow-up post EVAR.
Fig 3. Percentage of false-negative endoleaks using contrast-enhanced ultrasound (CEUS) and the relation to body mass index (BMI).
The number of patients undergoing EVAR, as are younger patients, is growing globally. This study has proven the ability of CEUS to detect endoleaks with high precision and it should have a role in EVAR follow-up. Incorporating CEUS into EVAR surveillance with CTA recommended for patients with increased BMIs should be a consideration.
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