title: Ultrasonographic surveillance with selective CTA after endovascular repair of abdominal aortic aneurysm.
abstract: OBJECTIVE
  To evaluate the agreement between color-coded duplex ultrasound (US) and computed tomographic angiography (CTA) in monitoring aneurysm diameter and detecting endoleaks after endovascular aneurysm repair (EVAR).
  
  
  METHODS
  From November 1998 to January 2007, 196 patients (191 men; mean age 72.4 years, range 52-88) underwent EVAR and were followed by CTA and US over a mean 3.9+/-2.4 years (range 0-8.9, median 3.4). Annual paired CTA and US examinations were reviewed to assess agreement in measuring maximum aneurysm transverse diameter and to evaluate diagnostic accuracy of US in detecting endoleak.
  
  
  RESULTS
  The 5-year cumulative endoleak incidence was 43.8% (72 patients). At first diagnosis, US detected 55/72 (76.4%) endoleaks; of the remaining 17, only 3 (4.3%) were clinically significant in terms of aneurysm enlargement. Pairing 709 annual CTA and US examinations from 184 patients showed a high agreement (k = 0.96) between examinations in measuring maximum transverse diameter, with a mean difference between US and CTA of -2.5 mm.
  
  
  CONCLUSIONS
  After the first year of follow-up, EVAR surveillance costs can be reduced by performing annual US examinations only. Keeping in mind that US underestimates diameter measurements, CTA can be reserved for patients with increasing or persistently stable aneurysm diameters.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Pisa, Italy. irenebargellini@hotmail.com
authors.forename: Irene
authors.initials: I
authors.lastname: Bargellini
authors.forename: Roberto
authors.initials: R
authors.lastname: Cioni
authors.forename: Vinicio
authors.initials: V
authors.lastname: Napoli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Petruzzi
authors.forename: Claudio
authors.initials: C
authors.lastname: Vignali
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicorelli
authors.forename: Savino
authors.initials: S
authors.lastname: Sardella
authors.forename: Mauro
authors.initials: M
authors.lastname: Ferrari
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color