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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2007 Marzo;14(1):1-8
Follow-up of type II endoleaks after endovascular aortic repair: the role of contrast-enhanced ultrasound
Freyrie A. 1, Serra C. 2, Testi G. 1, Rossi C. 1, Mauro R. 1, Faggioli G. L. 1, Stella A. 1
1 Unit of Vascular Surgery S. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy
2 Unit of Internal Medicine and Gastroenterology S. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy
3 Unit of Radiology S. Orsola-Malpighi Hospital University of Bologna, Bologna, Italy
Aim. The aim of this study was to prospectively evaluate the role of contrast-enhanced ultrasound (CEUS) for the detection of type II endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) in comparison with color-Doppler ultrasound (CDU) and computed tomography angiography (CTA).
Methods. Sixteen patients (all men with a mean age of 76 years ±11 years) who underwent EVAR, were submitted to CDU, CEUS and CTA. The patients were divided into 2 groups on the basis of the results of the CTA performed 6 months before: in 8 patients (Group 1), the CTA scan did not visualize any endoleak despite the absence of a significant reduction of the diameter of the aneurysm; in the other 8 patients (Group 2), the CTA scan revealed the presence of a type II endoleak. CEUS examinations were performed using a real-time low mechanical index harmonic ultrasound technique after intravenous injection of a second generation contrast agent (SonoVue®, Bracco, Italy). The CDU and CEUS findings were compared with the CTA findings which is considered the reference standard technique.
Results. Group 1: in one patient, CEUS showed a type II endoleak confirmed by CTA, but not visualized on CDU. Group 2: a type II endoleak was disclosed by CEUS in 7 patients, by CDU in 5 patients and by CTA in 6 patients. CEUS permitted the identification of an endoleak not visualized with CTA. In comparison with CTA, CDU and CEUS had a sensitivity of 71.4% and 100% respectively and a specificity of 100% and 88.9%, respectively. CEUS permitted the identification of inflow and outflow collateral vessels in 4 patients and the identification of only the inflow vessels in 2 patients.
Conclusion. In our experience, CEUS was found to be more sensitive than CDU and almost as sensitive as CTA in the detection of type II endoleaks. As compared to CTA, CEUS is better for identifying the hemodynamic characteristics of type II endoleaks. After EVAR, CEUS could replace CTA in the follow-up of patients with type II endoleaks.