Ultrasonographic surveillance with selective CTA after endovascular repair of abdominal aortic aneurysm.
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.
Bargellini
Irene
I
Department of Diagnostic and Interventional Radiology, University of Pisa, Italy. irenebargellini@hotmail.com
Cioni
Roberto
R
Napoli
Vinicio
V
Petruzzi
Pasquale
P
Vignali
Claudio
C
Cicorelli
Antonio
A
Sardella
Savino
S
Ferrari
Mauro
M
Bartolozzi
Carlo
C
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