Postoperative color flow duplex scanning in aortic endografting.
OBJECTIVE
To report the feasibility and sensitivity of duplex sonography compared to computed tomography (CT) for aortic endograft follow-up surveillance.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Heilberger
P
P
Department of Vascular Surgery, Klinikum Nürnberg Süd, Germany.
Schunn
C
C
Ritter
W
W
Weber
S
S
Raithel
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology; D001807:Blood Vessel Prosthesis; D003287:Contrast Media; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011134:Polysaccharides; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508