Contrast-Enhanced Ultrasound in the Follow-Up of Endoleaks after Endovascular Aortic Repair (EVAR)

Rübenthaler, Johannes; Zimmermann, Hanna; Armbruster, Marco; Müller-Peltzer, Katharina; Bogner, Florian; Reiser, Maximilian; Clevert, D.‐A.

doi:10.1055/s-0043-108207

Cited by 13 publications

(5 citation statements)

References 65 publications

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“…12 For long-term follow-up, ultrasound is becoming popular due to decreased radiation exposure, no dye exposure, and cost-effectiveness. 15 In this case, size of AAA at the time of EVAR and followup AAA size showed no increases in the sac size and CTA ruled out any endoleak.…”

Section: Discussionmentioning

confidence: 60%

See 1 more Smart Citation

Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience

Kichloo

Khan

El-Amir

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

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Abdominal aortic aneurysm (AAA) is one of the important pathologies involving the abdominal aorta, as it can have adverse consequences if it goes unnoticed or untreated. AAA is defined as an abnormal dilation of the abdominal aorta 3 cm or greater. Endovascular abdominal aortic aneurysm repair (EVAR) has recently emerged as a treatment modality for AAA. It does have a few inherent complications that include endoleak, endograft migration, bleeding, ischemia, and compartment syndrome. This case report discusses a patient who came in with abdominal pain and a pulsatile mass, which raised concerns regarding endoleak. The patient had a 9.9-cm AAA, which was repaired in the past, as was made evident by computed tomography findings of the stent graft in the aneurysmal segment. This case stands out because it highlights the importance of comparing the size of the AAA at the time of the EVAR to the current scenario where the patient presents with abdominal pain of unknown etiology. Also, this case report highlights the importance of computed tomography and other imaging forms in following-up with patients who have EVAR for AAAs.

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Section: Discussionmentioning

confidence: 60%

“…12 For long-term follow-up, ultrasound is becoming popular due to decreased radiation exposure, no dye exposure, and cost-effectiveness. 15…”

Section: Discussionmentioning

confidence: 99%

Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience

Kichloo

Khan

El-Amir

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

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“…der bildgebenden Modalität unterscheiden sich die Leitlinien: So wird bei den amerikanischen Guidelines der Ultraschall (US) mit Ausnahme der ersten Nachuntersuchung gleichwertig zur CTA gewertet, während die europäischen Leitlinien sogar den US vorrangig empfehlen, vor allem für die jährlichen Verlaufskontrollen, während die CTA nur bei den Kontrollen alle 5 Jahre zum Einsatz kommen soll. In diesem Bereich kann insbesondere der kontrastmittelverstärkte Ultraschall punkten, der bei deutlich niedrigeren Kosten eine höhere Sensitivität zur Detektion von Endoleaks als die CTA aufweist, insbesondere bei Typ-II-Endoleaks [ 18 , 22 , 50 , 56 ].…”

Section: Typ Vunclassified

Endovaskuläre Aortenreparatur bei Endoleaks

Hauck

Schernthaner²,

Dachs

et al. 2022

Radiologie

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ZusammenfassungSämtliche Patienten nach endovaskulärer Versorgung eines Aortenaneurysmas bedürfen einer regelmäßigen Nachkontrolle, zumeist in jährlichem Abstand. Der kontrastmittelverstärkte Ultraschall und die Computertomographie-Angiographie (CTA) sind die wichtigsten diagnostischen Modalitäten für die Erkennung von Endoleaks. Die (CTA) erlaubt eine bessere Unterscheidung der verschiedenen Endoleak-Typen. Sogenannte Hochdruck-Endoleaks (Typ I und Typ III) stellen, wenn sich nicht kurzzeitig ein Spontanverschluss zeigt, eine absolute Indikation zur Nachbehandlung dar. Typ-II-Endoleaks weisen in der Mehrzahl einen benignen Verlauf auf. Wenn kein Wachstum des Aneurysmasacks erfolgt, kann eine Nachkontrolle im gewohnten Intervall durchgeführt werden. Typ-II-Endoleaks mit assoziiertem Wachstum des Aneurysmasacks können durch Embolisation der verantwortlichen Gefäße behandelt werden. Ob eine Behandlung immer durchgeführt werden muss, ist umstritten. Eine Behandlungsindikation von einem Typ-II-Endoleak mit wachsendem Aneurysmasack ist jedoch gegeben, wenn durch eine Verkürzung des Aneurysmahalses ein sekundäres Typ-I-Endoleak droht. Typ-I-Endoleaks stellen die Hauptlimitation der Stentgraft-Therapie dar. Die beste Prävention eines Typ-I-Endoleaks ist die Bereitstellung einer adäquaten proximalen Landezone. Dies kann durchaus bedeuten, dass fenestrierte Stentgrafts verwendet werden müssen. Die Verwendung von Schrauben oder anderen Fixationsinstrumenten zur sicheren Behandlung auch kurzer Hälse ist derzeit noch in der Studienphase.

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“…In comparison to CT, CEUS has many perks, including the absence of radiation exposure, the use of a contrast medium that is not nephrotoxic, lower economic burden, and shorter acquisition times [45].…”

Section: Role Of Ceus In the Surveillance Protocol Of Evarmentioning

confidence: 99%

Role of CEUS in Vascular Pathology

et al. 2021

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In recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.

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Contrast-Enhanced Ultrasound in the Follow-Up of Endoleaks after Endovascular Aortic Repair (EVAR)

Cited by 13 publications

References 65 publications

Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience

Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience

Endovaskuläre Aortenreparatur bei Endoleaks

Role of CEUS in Vascular Pathology

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