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Clinical Trial
. 2015 Sep 20;128(18):2491-7.
doi: 10.4103/0366-6999.164935.

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Xiao Yang, Yue-Xin Chen, Bo Zhang, Yu-Xin Jiang  1 , Chang-Wei Liu, Rui-Na Zhao, Qiong Wu, Da-Ming Zhang
Affiliations
Clinical Trial

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Xiao Yang et al. Chin Med J (Engl). .

Abstract

Background: Endovascular aneurysm repair (EVAR) is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography (CTA), which is routine for follow-up, has side effects (e.g., radiation) and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound (CEUS) have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak.

Methods: Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging (CDFI) and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDFI was conducted using Fisher's exact test and clinical outcomes of all patients were followed up.

Results: Sixteen patients were enrolled, and 12 (75%) had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFI-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically different (P = 0.008). Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type III endoleak had open surgery when endovascular repair failed.

Conclusions: CEUS is a new, safe, and effective means for detection of endoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

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Figures

Figure 1
Figure 1
A 84-year-old male patient, postendovascular aneurysm repair. (a) Computed tomography angiography shows no endoleak. S: Stent (red arrow). (b) Gray-scale ultrasound. (c) Contrast-enhanced ultrasound shows a small endoleak lateral to the upper end of the stent (type Ia) (white arrow). (d) After re-intervention, contrast-enhanced ultrasound shows no endoleak (yellow arrow).
Figure 2
Figure 2
A 83-year-old male patient, postendovascular aneurysm repair. (a) Computed tomography angiography shows contrast agent around the stent with obscure leak site (green arrow). (b) Contrast-enhanced ultrasound shows leak at the lower part of the stent's right leg (type Ib) (white arrow). (c) Color Doppler flow imaging shows outflow from the stent (white arrow).
Figure 3
Figure 3
A 71-year-old female patient, postendovascular aneurysm repair. (a) Computed tomography angiography shows an endoleak in an aneurysm (red arrow). (b) Color Doppler flow imaging shows the leak's origin from an inferior mesenteric artery (white arrow). (c) Contrast-enhanced ultrasound demonstrates two reflux flow (red arrows), and (d) the flow unseen by color Doppler flow imaging and computed tomography angiography travels horizontally (red arrow).
See this image and copyright information in PMC

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