[Duplex ultrasound detection of type II endoleaks by after endovascular aneurysm repair: interest of contrast enhancement]

Abstract

Objective: Type II endoleaks (EFII) are related to retrograde flow via aorta tributaries. They are the most frequent complication after endovascular aneurysm repair (EVAR). We hypothesized that the use of contrast-enhanced ultrasound (CEUS) by an experienced vascular physician could increase the sensitivity of detecting EFII compared with computed tomography angiography (CTA) taken as the gold standard.

Material and method: From November 2010 to February 2013, patients with EVAR were included prospectively. All patients had a color duplex ultrasound (CDU), CEUS and CTA. Sensitivity, specificity and kappa's coefficient were determined to estimate the performance of CDU and CEUS to assess EFII compared with CTA.

Results: Sixty CDU and 60 CEUS explorations were compared to 60 CTA explorations. Nineteen type EFII were detected by CTA, 14 by CDU and 15 by CEUS. CDU sensitivity was 74% (κ=0.75), and CEUS sensitivity was 78% (κ=0.8). Both tests exhibited 97% specificity. There was good agreement between CDU results (κ=0.75) and CEUS results (κ=0.8) compared with CTA. There was very good agreement between CDU and CEUS results for detection of EFII (κ=0.93). There was no statistically significant difference between the sensitivity of CDU and CEUS (P=0.32).

Conclusion: Our results suggest that contrast enhancement does not increase yield for ultrasound detection of type II endoleaks when performed by an experienced vascular physician.

Keywords: Abdominal aorta aneurysm; Agent de contraste; Anévrysme de l’aorte abdominale; Computed tomography; Contrast-enhanced ultrasound; Duplex ultrasound; Endoprothèse aortique; Endovascular aneurysm repair; Tomodensitométrie; Échographie-doppler.