Current Clinical Practice in Postoperative Endovascular Aneurysm Repair Imaging Surveillance

Uthoff, Heiko; Peña, Constantino; Katzen, Barry T.; Gandhi, Ripal; West, James E.; Benenati, James F.; Geisbüsch, Philipp

doi:10.1016/j.jvir.2012.06.003

Cited by 31 publications

(29 citation statements)

References 22 publications

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“…At the moment, triphasic CT is considered the reference procedure in the follow-up of patients who have undergone EVAR, because it allows a good identification of endoleaks [18,19,22]. Pre-and post-contrast scans in the arterial phase allow the identification of small endoleaks adjacent to the metal parts and calcifications, and lowflow endoleaks, visible in delayed scans.…”

Section: Discussionmentioning

confidence: 99%

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

David

Cantisani

Grazhdani³

et al. 2016

J Ultrasound

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Objective To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in comparison to CT angiography (CTA) to identify and classify endoleaks following abdominal aortic aneurism repair with endoprosthesis. Materials and methods A retrospective analysis of 181 patients treated with EVAR, from September 2009 to September 2014, was performed. Patients were evaluated with CEUS, CTA and angiography in the cases requiring treatment. Sac diameter, sac integrity, identification and classification of endoleaks were taken into consideration. Sensitivity, specificity, accuracy and negative predictive values were considered for each modality of endoleak identification. Results Forty-two endoleaks (23.2%; type II: 39 cases, type III: 3 cases) were documented. Sensitivity and specificity of CEUS and CT were, respectively, 97.6 and 90.5, 100 and 100%. In two cases, CEUS was able to better classify endoleaks compared to CT. Conclusions CEUS accuracy to identify endoleaks following EVAR is similar to CT. CEUS should be considered as an effective modality for the long-term surveillance of EVAR because of its capability to correctly classify endoleaks with no ionizing radiation exposure.Keywords Contrast-enhanced ultrasound Á CT Á Endoleak Riassunto Obiettivi dello studio Valutare l'accuratezza dell'ecocontrastografia (CEUS), confrontandola con angiografia con tomografia computerizzata (CT) per l'identificazione degli endoleak dopo trattamento di aneurisma dell'aorta addominale con endoprotesi. Materiali Da Settembre 2008 a Dicembre 2014, 181 pazienti consecutivi trattati con EVAR sono stati valutati con CEUS, CTA, ed anche con angiografia nei casi da ritrattare. Sono stati valutati: diametro della sacca, valutazione dell'integrita della sacca, identificazione e classificazione degli endoleaks. Sensibilità, specificità, accuratezza e valore predittivo negativo sono stati valutati per ogni modalita nell'identificazione degli endoleak. Risultati Quarantadue endoleak (23.2%; tipo II: 39 casi, tipo III: 3 casi) sono stati documentati. La Sensibilita della CEUS e della TC e stata rispettivamente del 97.6, 90.5%, mentre la specificita per entrambe e stata del 100%. In due casi la CEUS e stata in grado di classificare meglio gli endoleak rispetto alla CT. La sacca aneurismatica presentava alla CEUS e CDUS un diametro massimo compreso tra 39-82 mm, mentre alla TC tra 38 e 78 mm, senza significativa differenza tra le due metodiche. Conclusioni L'accuratezza della CEUS nell'identificazione degli endoleak e nella misurazione della sacca dopo EVAR, e simile alla TC con maggiore sensibilita ma analoga specificita. La CEUS e da considerarsi una modalita efficace per la sorveglianza a lungo termine degli EVAR in quanto capace di classificare correttamente gli endoleak senza esposizione a radiazioni ionizzanti.Parolechiave Contrast-enhanced ultrasound Á CT Á Endoleak

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Section: Discussionmentioning

confidence: 99%

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

David

Cantisani

Grazhdani³

et al. 2016

J Ultrasound

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“…Concerns with current practice include the diagnostic accuracy of different imaging modalities, patient attendance rates, interval presentations leading to reintervention, and nephrotoxicity and radiation exposure from CT. This uncertainty is reflected by wide variations in surveillance protocols used at different centres.…”

Section: Discussionmentioning

confidence: 99%

International validation of a risk score for complications and reinterventions after endovascular aneurysm repair

Karthikesalingam¹,

Vidal‐Diez²,

Bruin³

et al. 2015

British Journal of Surgery

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“…A typical routine for postprocedural surveillance is CT angiography at 1 month, 6 months, and then yearly after EVAR (35). The Society of Interventional Radiology, Society for Vascular Surgery, European Society for Vascular Surgery, and Cardiovascular and Interventional Radiological Society of Europe currently uniformly advocate lifelong imaging surveillance (36).…”

Section: Postprocedural Imaging Surveillancementioning

confidence: 99%

“…Contrast-enhanced MR imaging can be performed with nitinol-based stents (35). Elgiloy stents can obscure the lumen, and stainless-steel stents can cause artifacts (35).…”

Section: Postprocedural Imaging Surveillancementioning

confidence: 99%

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Endovascular Repair of Abdominal Aortic Aneurysms: Vascular Anatomy, Device Selection, Procedure, and Procedure-specific Complications

Bryce¹,

Rogoff²,

Romanelli³

et al. 2015

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Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR.

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Current Clinical Practice in Postoperative Endovascular Aneurysm Repair Imaging Surveillance

Cited by 31 publications

References 22 publications

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

International validation of a risk score for complications and reinterventions after endovascular aneurysm repair

Endovascular Repair of Abdominal Aortic Aneurysms: Vascular Anatomy, Device Selection, Procedure, and Procedure-specific Complications

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