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Review
. 2015 Dec;5(6):454-63.
doi: 10.3978/j.issn.2223-3652.2015.09.04.

Contrast-enhanced ultrasound after endovascular aortic repair-current status and future perspectives

Sasan Partovi  1 , Mathias Kaspar  1 , Markus Aschwanden  1 , Charles Lopresti  1 , Shivanshu Madan  1 , Heiko Uthoff  1 , Stephan Imfeld  1 , Daniel Staub  1
Affiliations
Review

Contrast-enhanced ultrasound after endovascular aortic repair-current status and future perspectives

Sasan Partovi et al. Cardiovasc Diagn Ther. 2015 Dec.

Abstract

An increasing number of patients with abdominal aortic aneurysms (AAAs) are undergoing endovascular aortic repair (EVAR) instead of open surgery. These patients require lifelong surveillance, and the follow-up imaging modality of choice has been traditionally computed tomography angiography (CTA). Repetitive CTA imaging is associated with cumulative radiation exposure and requires the administration of multiple doses of nephrotoxic contrast agents. Contrast-enhanced ultrasound (CEUS) has emerged as an alternative strategy in the follow-up of patients with EVAR and demonstrates high sensitivity and specificity for detection of endoleaks. In fact, a series of studies have shown that CEUS is at least performing equal to computed tomography for the detection and classification of endoleaks. This article summarizes current evidence of CEUS after EVAR and demonstrates its usefulness via various patient cases.

Keywords: Contrast-enhanced ultrasound (CEUS); abdominal aortic aneurysm (AAA); endovascular aortic repair (EVAR).

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Conflict of interest statement

Conflicts of Interest: Dr. Staub is supported by an unrestricted research grant from Bracco Suisse SA, Manno, Switzerland. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Standard and contrast-enhanced ultrasound in a patient with type II endoleak from a lumbar artery after endovascular aortic repair (EVAR). (A) Cross-sectional view of the infrarenal aorta. Detection of an endoleak (arrow) using color and pulse-wave ultrasonics; spectral curve with a typical to-and-fro signal. (B,C,D) Cross-sectional view of the infrarenal aorta. Contrast mode (left) and conventional B-mode (right) simultaneously; (B) 48 sec after bolus injection of contrast agent extravascular enhancement is shown (arrow) within the aneurysm sack; (C) 55 sec after bolus injection increasing extravascular enhancement is seen directed towards the dorsal wall of the aneurysm sack (arrow); (D) 80 sec after bolus injection, showing extended extravascular enhancement within the aneurysm sac.
Figure 2
Figure 2
Standard and contrast-enhanced ultrasound in a patient with type II endoleak after endovascular aortic repair (EVAR). Cross-sectional view of the infrarenal aorta. (A) Detection of a slow flow endoleak (arrow) using color and pulse-wave ultrasound; spectral curve with to-and-fro signal; (B) contrast mode 30 sec after bolus injection, showing no extravascular enhancement; (C) contrast mode (left) and conventional B-mode (right) simultaneously, 210 sec after bolus injection, showing endoleak (arrow), dorsal and lateral of the left prosthetic limb; pseudoenhancement (star) outside the aneurysm sack (circle).
Figure 3
Figure 3
Contrast-enhanced ultrasound in a patient without endoleak after endovascular aortic repair (EVAR). Cross-sectional view of the infrarenal aorta; contrast mode (left) and conventional B-mode (right) simultaneously, 30 sec (A), 45 sec (B) and 72 sec (C) after bolus injection, no endoleak; (D) sagittal view of the infrarenal aorta; contrast mode 260 sec after bolus injection, no endoleak.
See this image and copyright information in PMC

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