title: Contrast-enhanced ultrasound vs. CT angiography in fenestrated EVAR surveillance: a single-center comparison.
abstract: OBJECTIVE
  To evaluate contrast-enhanced ultrasound (CEUS) as an effective alternative to computed tomographic angiography (CTA) during follow-up after fenestrated endovascular aneurysm repair (EVAR) of juxtarenal aortic aneurysms.
  
  
  METHODS
  Between January 2008 and April 2011, 62 patients (all men; mean age 72 years) underwent fenestrated EVAR follow-up with both CTA and CEUS. In a retrospective analysis, the first CTA and CEUS postoperative examinations after EVAR were compared for endoleak detection, aneurysm sac diameter, and target vessel patency. The examinations were performed within 30 days of the procedure and the interval between the 2 scans was <7 days. Only fenestrated endografts with up to 3 fenestrations (with or without a scallop) were eligible so that the entire implant could be visualized with standard abdominal ultrasound.
  
  
  RESULTS
  The mean diameters of the aneurysm sac were 56.58±8.56 mm with CEUS and 57.70±8.59 mm with CTA. The mean difference in aneurysm sac diameter was -1.13±3.19 mm (95% CI -0.34 to -1.92), with CTA measurements tending to be slightly larger. Bland-Altman plots showed good agreement between the imaging modalities with respect to aneurysm sac diameter (Spearman correlation coefficient r(s)=0.921, p<0.01). Endoleaks were detected by CTA in 7 (11.3%) of 62 patients and by CEUS in 6 (9.7%). In 59 (95.16%) cases, the tests agreed, and their equivalence was confirmed by binomial distribution testing. There was complete agreement between CEUS and CTA in the assessment of target vessels (144/146 patent target arteries; 1 had a significant stenosis and another was thrombosed).
  
  
  CONCLUSIONS
  CEUS is as accurate as CTA in endoleak detection, abdominal aortic aneurysm diameter measurement, and the evaluation of target vessels during surveillance of fenestrated stent-grafts. Although it cannot yet be proposed as the only imaging modality during follow-up, CEUS could be usefully employed with the self-evident advantage of reducing lifetime exposure to ionizing radiation.
authors.affiliation: Department of Vascular Surgery, Université Lille Nord de France, Hôpital Cardiologique, CHRU de Lille, France.
authors.forename: Paolo
authors.initials: P
authors.lastname: Perini
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sediri
authors.forename: Marco
authors.initials: M
authors.lastname: Midulla
authors.forename: Pascal
authors.initials: P
authors.lastname: Delsart
authors.forename: Corinne
authors.initials: C
authors.lastname: Gautier
authors.forename: Stéphan
authors.initials: S
authors.lastname: Haulon
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D003287:Contrast Media; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005602:France; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D010743:Phospholipids; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013459:Sulfur Hexafluoride; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride