The role of contrast-enhanced ultrasound imaging in the follow-up of patients post-endovascular aneurysm repair

Abstract

Endovascular aneurysm repair is a minimally invasive technique for the treatment of abdominal aortic aneurysms. Patients who undergo endovascular aneurysm repair are potentially at risk of developing problems related to the graft such as the development of endoleaks. Endoleaks can cause expansion of the aneurysmal sac, which can potentially lead to rupture. It is for this reason that lifelong surveillance of patients is required to assess the graft and the aneurysmal sac. This article discusses the role of contrast-enhanced ultrasound in the follow-up of patients post-endovascular aneurysm repair. Contrast-enhanced ultrasound is rapidly becoming a powerful, accurate and cost-effective tool to complement computed tomography in the follow-up of endovascular aneurysm repair patients. Real-time imaging of contrast filling into the arterial system means that contrast-enhanced ultrasound is an excellent problem-solving tool, particularly when assessing for the type and anatomy of endoleaks. In some instances, contrast-enhanced ultrasound can detect endoleaks when other modalities are equivocal.

Pseudoendoleak: A post‐endovascular aortic repair ultrasound surveillance pitfall – Single institution case series

“…A number of different imaging modalities may be used for post‐EVAR surveillance, primarily CTA and CDUS. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) are rarely used 4,5 . Computed tomography angiography (CTA) and CDUS assess changes in aneurysm sac size and for the presence of endoleaks.…”

“…Indeed, in many studies, it is shown to have a higher sensitivity than CTA 8,9 . CEUS is used at our institution in cases where there is sac expansion with no endoleak seen on CT or CDUS, given its improved sensitivity 4,10 . Of note, in Australia, CEUS is not currently Medicare rebateable for post‐EVAR imaging.…”

“…Contrast‐enhanced ultrasound has the advantage over CT of incorporating time‐resolved assessment and its use in differentiating Type 1 and Type 2 endoleak based on this property is described 4 . Indeed, in many studies, it is shown to have a higher sensitivity than CTA 8,9 .…”

“…Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) are rarely used. 4 , 5 Computed tomography angiography (CTA) and CDUS assess changes in aneurysm sac size and for the presence of endoleaks. While literature demonstrates decreased sensitivity of CDUS compared with CTA, there are distinct advantages of ultrasound with a lack of ionising radiation, potentially nephrotoxic contrast and improved temporal resolution.…”

“…Contrast‐enhanced ultrasound has the advantage over CT of incorporating time‐resolved assessment and its use in differentiating Type 1 and Type 2 endoleak based on this property is described. 4 Indeed, in many studies, it is shown to have a higher sensitivity than CTA. 8 , 9 CEUS is used at our institution in cases where there is sac expansion with no endoleak seen on CT or CDUS, given its improved sensitivity.…”