title: Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair.
abstract: BACKGROUND
  Previous analyses suggested that duplex ultrasonography (DUS) detected endoleaks after endovascular aneurysm repair (EVAR) with insufficient sensitivity; they did not specifically examine types 1 and 3 endoleak, which, if untreated, may lead to aneurysm-related death. In light of changes to clinical practice, the diagnostic accuracy of DUS and contrast-enhanced ultrasonography (CEUS) for types 1 and 3 endoleak required focused reappraisal.
  
  
  METHODS
  Studies comparing DUS or CEUS with computed tomography (CT) for endoleak detection were identified. CT was taken as the standard in bivariable meta-analysis.
  
  
  RESULTS
  Twenty-five studies (3975 paired scans) compared DUS with CT for all endoleaks. The pooled sensitivity was 0·74 (95 per cent confidence interval 0·62 to 0·83) and the pooled specificity was 0·94 (0·90 to 0·97). Thirteen studies (2650 paired scans) reported detection of types 1 and 3 endoleak by DUS; the pooled sensitivity of DUS was 0·83 (0·40 to 0·97) and the pooled specificity was 1·00 (0·97 to 1·00). Eleven studies (961 paired scans) compared CEUS with CT for all endoleaks. The pooled sensitivity of CEUS was 0·96 (0·85 to 0·99) and the pooled specificity was 0·85 (0·76 to 0·92). Eight studies (887 paired scans) reported detection of types 1 and 3 endoleak by CEUS. The pooled sensitivity of CEUS was 0·99 (0·25 to 1·00) and the pooled specificity was 1·00 (0·98 to 1·00).
  
  
  CONCLUSIONS
  Both CEUS and DUS were specific for detection of types 1 and 3 endoleak. Estimates of their sensitivity were uncertain but there was no evidence of a clinically important difference. DUS detects types 1 and 3 endoleak with sufficient accuracy for surveillance after EVAR.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital, London, UK. akarthik@sgul.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: W
authors.initials: W
authors.lastname: Al-Jundi
authors.forename: D
authors.initials: D
authors.lastname: Jackson
authors.forename: J R
authors.initials: JR
authors.lastname: Boyle
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003287:Contrast Media; D057867:Endoleak / Q000175:diagnosis; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D003287:Contrast Media