Contrast-enhanced Duplex surveillance after endovascular abdominal aortic aneurysm repair: improved efficacy using a continuous infusion technique.
BACKGROUND
Currently, postoperative endoleak surveillance after endovascular aortic aneurysm repair (EVAR) is primarily done by computed tomography (CT). The purpose of this study was to determine the efficacy of contrast-enhanced ultrasonography scans to detect endoleaks by using a novel infusion method and compare these findings with those of CT angiography (CTA).


METHODS
Twenty male patients (mean age, 70.4 years) underwent surveillance utilizing both CTA and contrast-enhanced color Duplex imaging. One 3-mL vial of Optison (Perfluten Protein A microspheres for injection) and 57 mL normal saline, for a total of 60 mL, were administered to each patient as a continuous infusion at 4 mL/min via a peripheral vein. Each study was optimized with harmonic imaging, and a reduced mechanical index of 0.4 to 0.5, compression of 1 to 3, and a focal zone below the aorta to minimize microsphere rupture. One minute was allowed from the time of infusion to the appearance of contrast in the endograft. Flow was evaluated within the lumen of the graft and its components, as was the presence or absence of endoleaks. Findings were compared with standard color-flow Duplex imaging and CT utilizing CTA reconstruction protocols.


RESULTS
All patients evaluated had modular endografts implanted for elective aneurysm repair. Contrast-enhanced duplex scans identified nine endoleaks: one type I and eight type II. No additional endoleaks were seen on CTA. However, CTA failed to recognize three type II endoleaks seen by contrast-enhanced ultrasound. The continuous infusion method allowed for longer and more detailed imaging. An average of 46.8 mL of the contrast infusion solution was used per patient.


CONCLUSIONS
Contrast enhanced Duplex ultrasonography accurately demonstrates endoleaks after EVAR and may be considered as a primary surveillance modality. Continuous infusion permits longer imaging time.
Baylor College of Medicine, Houston, Texas 77030-3411, USA. surgmax@hotmail.com
Esteban A
EA
Henao
Megan D
MD
Hodge
Deborah D
DD
Felkai
Charles H
CH
McCollum
George P
GP
Noon
Peter H
PH
Lin
Alan B
AB
Lumsden
Ruth L
RL
Bush
D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D003287:Contrast Media / Q000008:administration & dosage*; D005466:Fluorocarbons / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons