title: Contrast Enhanced Ultrasound can Replace Computed Tomography Angiography for Surveillance After Endovascular Aortic Aneurysm Repair.
abstract: Surveillance after endovascular aortic aneurysm repair (EVAR) is mandatory and computed tomography angiography (CTA) is considered the standard imaging modality, although patients are exposed to ionizing radiation and nephrotoxic contrast medium. The primary aim of this study was to determine the diagnostic efficacy of duplex ultrasound (DUS) and contrast enhanced ultrasound (CEUS) using CTA as the gold standard. The secondary aim was to determine the clinical consequences of endoleaks missed by DUS and CEUS, or CTA.
  
  
  
  All patients with EVAR for an aorto-iliac aneurysm between 1 August 2011 and 31 October 2014 were prospectively and consecutively enrolled. CEUS was added to the existing surveillance protocol, which included DUS, plain abdominal X-ray, and CTA at 3 and 12 months after stent implantation.
  
  
  
  In 278 patients, endoleaks were detected in 68, 69, and 46 cases by CTA, CEUS, and DUS, respectively. The sensitivity and specificity of DUS and CEUS were 46% and 93%, and 85% and 95%, respectively. CEUS and CTA were diagnostically equivalent, as opposed to DUS and CTA (p = .002). Endoleaks detected by CTA led to re-intervention in 11 (4%) patients. These endoleaks were also detected by CEUS; however, three out of 11 patients were missed by DUS and underwent re-intervention: limb extension, re-cuff, and attempt to coil lumbar leaks. Endoleaks missed by CEUS or CTA were type II endoleaks without sac expansion.
  
  
  
  In surveillance programs after EVAR a diagnostic CEUS examination may replace CTA.
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: kim.kargaard.bredahl@regionh.dk.
authors.forename: K K
authors.initials: KK
authors.lastname: Bredahl
authors.affiliation: Department of Interventional Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Taudorf
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Interventional Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Lönn
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: K C
authors.initials: KC
authors.lastname: Vogt
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Sillesen
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: J P
authors.initials: JP
authors.lastname: Eiberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; 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; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D057867:Endoleak / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D010743:Phospholipids / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015607:Stents; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Abdominal; Aortic aneurysm; Contrast enhanced; Endoleak; Imaging; Tomography; Ultrasonography; X-ray computed