shu-508 and Aortic-Aneurysm--Abdominal

To compare unenhanced and enhanced ultrasound imaging to biphasic computed tomography (CT) in the detection of endoleak after endovascular abdominal aortic aneurysm (AAA) repair.. Fifty-three patients (44 men; mean age 70 years) were examined during 96 follow-up visits after endovascular AAA repair. All patients had color Doppler and power Doppler ultrasound studies performed before and after the administration of an ultrasound contrast agent. Biphasic (arterial and delayed) CT was performed on the same day, and the ultrasound and CT studies were independently scored to record the presence or absence of endoleak and the level of confidence in the observation.. The sensitivity of the ultrasound techniques to detect endoleak improved with the use of ultrasound contrast media, ranging from a low of 12% with unenhanced color Doppler to 50% with enhanced power Doppler. However, the enhanced power Doppler failed to detect 9 type II endoleaks identified by CT (86% negative predictive value for endoleak). There were only 2 graft-related endoleaks in the study; one was diagnosed from the ultrasound image, but the other had nondiagnostic ultrasound scans because of poor views.. Ultrasound scanning with or without contrast enhancement was not as reliable as CT in diagnosing type II endoleak. CT imaging remains our surveillance modality of choice.

Topics: Aged; Aortic Aneurysm, Abdominal; Contrast Media; Female; Humans; Male; Polysaccharides; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

To investigate the use of contrast-enhanced ultrasound in the detection of endoleak after endovascular repair of abdominal aortic aneurysm.. Eighteen patients underwent follow-up on 20 occasions after endovascular aortic aneurysm repair by arterial-phase contrast-enhanced spiral computed tomography (CT). All patients had unenhanced color Doppler ultrasound and Levovist-enhanced ultrasound on the same day. The ultrasound examinations were reported in a manner that was blind to the CT results. CT was regarded as the gold standard for the purposes of the study.. There were three endoleaks shown by CT. Unenhanced ultrasound detected only one endoleak (sensitivity, 33%). Levovist-enhanced ultrasound detected all three endoleaks (sensitivity, 100%). Levovist-enhanced ultrasound indicated an additional six endoleaks that were not confirmed by CT (specificity, 67%; positive predictive value, 33%). In one of these six cases, the aneurysm increased in size, which indicates a likelihood of endoleak. Two of the remaining false-positive results occurred in patients known to have a distal implantation leak at completion angiography.. In this small group of patients, contrast-enhanced ultrasound appears to be a reliable screening test for endoleak. The false-positive results with enhanced ultrasound may be due to the failure of CT to detect slow flow collateral pathways. Although the number of patients in this study is small, enhanced ultrasound may be more reliable than CT in detecting endoleak.

Topics: Aged; Angiography; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Contrast Media; Female; Follow-Up Studies; Humans; Injections, Intravenous; Male; Middle Aged; Polysaccharides; Postoperative Hemorrhage; Predictive Value of Tests; Prosthesis Failure; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

To report the feasibility and sensitivity of duplex sonography compared to computed tomography (CT) for aortic endograft follow-up surveillance.. In a 26-month period, 113 aortic aneurysm patients received 79 tube and 34 bifurcated stent-grafts. Follow-up used contrast-enhanced CT scanning and duplex sonography with an intravenous ultrasound contrast agent (Levovist).. Eleven patients (9.7%) were converted to open repair; 1 died from hemorrhagic shock secondary to retroperitoneal hematoma. The mean follow-up time was 7.2 months (range 1 to 24), during which 5 patients died of unrelated causes. Sixteen primary (within 30 days) and 5 secondary endoleaks were detected by duplex after tube graft implantation. Among 5 endoleaks due to retrograde side-branch perfusion, 3 were detected only with contrast-enhanced duplex scanning. Iliac artery occlusion was also documented using duplex; however, 2 stent fractures could not be seen with ultrasound. Ten primary endoleaks were detected in bifurcated stent-graft patients. One endoleak originating from the distal iliac limb anchoring site was missed by duplex owing to bowel gas. Graft limb thrombosis was clearly identified by lack of a flow signal on duplex.. Duplex sonography could be a valuable, reliable, and economical surveillance tool for endovascular aortic reconstructions. The adjunctive use of an intravenous ultrasound contrast agent increased the sensitivity for detecting endoleak to a level comparable to contrast-enhanced CT scanning. However, stent fractures may not be seen on ultrasound, and bowel gas can interfere with obtaining an adequate image.

Topics: Adult; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Blood Flow Velocity; Blood Vessel Prosthesis; Contrast Media; Follow-Up Studies; Humans; Middle Aged; Polysaccharides; Postoperative Hemorrhage; Retrospective Studies; Sensitivity and Specificity; Stents; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color