title: Pre-discharge duplex ultrasound scans detect endoleaks not seen on completion angiography after endovascular aneurysm repair.
abstract: OBJECTIVE
  To determine whether a pre-discharge duplex ultrasound scan detects early endoleaks that would not otherwise have been identified.
  
  
  METHODS
  A retrospective review was conducted of all patients undergoing elective infrarenal endovascular aneurysm repair (EVAR) at our center. These patients underwent intraoperative completion angiography, had a duplex ultrasound scan prior to hospital discharge, and were followed at 1, 3, and 6 months and at 6-month intervals thereafter. The outcome of any patients found to have an endoleak on a pre-discharge scan was studied.
  
  
  RESULTS
  There were 52 EVAR patients (50 men; mean age 76 years, range 61-87) with endoleak on the pre-discharge duplex: 17 (2.8%) type I, 28 (4.6%) type II, and 8 (1.3%) type III. Of these, only 7 of the type I and 2 of the type II leaks had been detected on completion angiography. Among the patients with type I endoleaks, 5 had resolution of the leak, 10 required further endovascular interventions, and 2 had open repair (1 died of aneurysm rupture). Two patients with failed endovascular repairs of the leak also had open repair. Fifteen of the 28 type II endoleaks resolved, 4 were treated with endovascular procedures, 1 had open repair, 7 are being observed, and 1 was lost to follow-up. Six of the 8 type III leaks resolved, 1 required open repair for an enlarging sac, and 1 is being observed.
  
  
  CONCLUSIONS
  Despite routine completion angiography, new endoleaks may be identified postoperatively, which suggests that more rigorous imaging at the point of completion angiography is required.
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, UK. bex125@hotmail.com
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Sandford
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Batchelder
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bown
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sayers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color