Colour Duplex and/or Contrast-Enhanced Ultrasound Compared with Computed Tomography Angiography for Endoleak Detection after Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Abstract

This study aims to assess the role of Color Duplex Ultrasound with or without contrast media for surveillance following endovascular aortic aneurysm repair (EVAR). A systematic search of the literature published until April 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The pooled rates of endoleak detection through Contrast-Enhanced or Color Duplex Ultrasound (CEUS or CDUS) and Computed Tomography Angiography (CTA) with 95% confidence intervals (CIs) were estimated using random-effect analysis. Thirty-eight studies were considered eligible for inclusion. The total number of patients in the included studies was 5214 between 1997 and 2021. The overall pooled rate of endoleak detection using CDUS and CTA was 82.59% and 97.22%, while the rates for CEUS and CTA were 96.67% and 92.82%, respectively. The findings of the present study support the use of the CEUS for endoleak detection. However, it should be integrated into institutional protocols for EVAR surveillance to further evaluate its clinical utility in the post-EVAR period before it can be recommended as the sole imaging modality after EVAR.

Ultrasound Coded‐Excitation Imaging for Endoleak Detection After Complex Endovascular Aortic Repair

“…Both techniques have already proven to be reliable in endoleak surveillance programs after EVAR. [18][19][20] Especially CEUS is discussed to, in some ways, be superior to CTA 21 due to the added advantage of angiodynamic resolution. 22 However, CEUS demands a high level of expertise also regarding the knowledge of specific aortic graft properties as well as distinct artifacts associated with the contrast-enhancers, 23 and is not reimbursed by health insurance services in various countries.…”

“…Subsequently, the use of other imaging modalities such as contrast‐enhanced ultrasonography (CEUS) 14,16 or regular color duplex sonography (DUS) 17 have been investigated repeatedly for the follow‐up of FEVAR procedures. Both techniques have already proven to be reliable in endoleak surveillance programs after EVAR 18–20 . Especially CEUS is discussed to, in some ways, be superior to CTA 21 due to the added advantage of angiodynamic resolution 22 .…”

Multimodality imaging and 3D-printing of a thoraco-abdominal aortic aneurysm eroding into the spine

“…MRI imaging is helpful to exclude another underlying malignant or infectious process of the spinal erosion. CEUS is highly sensitive for the detection of endoleaks [14] .…”

Review of Clinical Applications of Dual-Energy CT in Patients after Endovascular Aortic Repair

“…As a result, patients require regular imaging examinations to detect and classify endoleaks and identify other life-threatening complications, such as device thrombosis or infection. Various imaging modalities can be utilized during follow-up after EVAR; however, computed tomography angiography (CTA) and duplex ultrasound (DUS) are the basis for EVAR follow-up imaging [3] Despite the heterogeneous results of studies concerning the diagnostic accuracy of DUS [7,8] and its undeniable flaws (significant operator and patient dependencies), CTA is currently the reference standard Figure 1. Schematic illustration of the single-source rapid kVp-switching DECT system (GE Healthcare).…”