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Giornale Italiano di Chirurgia Vascolare 2001 March;8(1):33-42


language: English, Italian

Colour Duplex Scanning using contrast medium in the follow-up of patients given endograft treatment for abdominal aorta aneurysms

Maggio D., Udini M., Mazzei R., Palombo D.

From the Vascular Surgery Unit, Department of Cardiovascular Disease, Mauriziano Hospital, Turin, Italy


Background. A pros­pec­tive ­study was con­duct­ed in the ­course of the fol­low-up of ­patients giv­en endo­vas­cu­lar ­grafts as treat­ment for abdom­i­nal aor­ta aneu­rysms in ­order to com­pare the diag­nos­tic accu­ra­cy of ­colour ­duplex scan­ning and CT ­scans ­both ­using con­trast medi­um in the assess­ment of ­both post­op­er­a­tive ­leaks and vari­a­tions in diam­e­ter.
Methods. In November 1997 - June 1999, 29 ­patients (28 ­male and 1 ­female, ­mean age 69.5 ­years) ­were giv­en trans­fe­mo­ral Aneurex aor­tic endo­grafts. In 27 cas­es the prob­lem was fusi­form aneu­rysms of the sub­ren­al aor­ta and in 2 cas­es anas­to­mot­ic aor­tic pseu­do­an­eu­rysms in ­patients who had pre­vi­ous­ly ­been giv­en an aor­to­bif­e­mo­ral ­bypass. The 27 AAA ­patients ­were clas­si­fied on the ­basis of the Eurostar Protocol as Type A (4 ­patients), Type B (11), Type C (4), Type D (8) and Type E (0). In ­these cas­es the diam­e­ter ­range was 4.5-7 cm (­mean 5.2 cm). The ASA ­system was ­used to clas­si­fy the anaesthes­io­log­i­cal ­risk in ­these ­patients (ASA II 8 ­patients, ASA III 13, ASA IV 8). Follow-up at 1, 6, 12 and 18 ­months ­involved an abdom­i­nal X-ray, an abdom­i­nal CT ­scan ­using con­trast medi­um and an aor­toi­liac ­colour Duplex ­scan (ATL 3000 ­using a 4-2 MHz Convex ­probe) cor­o­nal and sag­it­tal ­scans ­being per­formed in ­basal con­di­tions and ­after infu­sions of Levovist ultra­sound con­trast medi­um.
Results. All sur­gi­cal pro­ce­dures ­were suc­cess­ful, ­none requir­ing sur­gi­cal con­ver­sion and ­with no ­deaths or ­major com­pli­ca­tions ­either in the imme­di­ate ­postoper­a­tive peri­od or dur­ing fol­low-up. Persistent endo­leak was not­ed in 3 ­patients (10.3%). They includ­ed 1 ­patient ­with a sec­on­dary (non-­graft-relat­ed) dis­tal ­leak, 1 ­with a pri­mary (­graft-relat­ed) dis­tal ­leak and a sec­on­dary ­leak, 1 ­with a pri­mary (­graft-relat­ed) prox­i­mal ­leak ­between the aor­tic ­cuff and the ­main ­body of the ­graft ­which was cor­rect­ed one ­month lat­er by the inser­tion of a sup­ple­men­tary aor­tic ­cuff. In all cas­es the ­results of the colour duplex and CT ­scans (­both ­using con­trast medi­um) ­were iden­ti­cal ­though the for­mer pro­duced ­more infor­ma­tion on ­blood ­flow. Among the 16 ­patients avail­able to at ­least 6 ­months' fol­low-up 15 (93.7%) ­revealed a reduc­tion in the diam­e­ter of the aneu­rys­mat­ic sac (­mean reduc­tion 3.45 mm) on CT ­scans, ­while 1 ­case (6.3%) ­revealed an ­increased diam­e­ter (2 mm). Colour duplex was ­less reli­able ­than CT in assess­ing aneu­rysm diam­e­ter.
Conclusions. Preliminary ­results con­firm the com­par­able effi­ca­cy of colour duplex and CT scan­ning ­using con­trast medi­um in the iden­tifi­ca­tion of post­op­er­a­tive ­leaks fol­low­ing endo­vas­cu­lar treat­ment of the aor­ta. The use of ultra­sound con­trast medi­um ­appears to ­enhance the sen­si­tiv­ity of ­that tech­nique par­tic­u­lar­ly in the iden­tifi­ca­tion of ­minor ­leaks, ­while colour duplex ­scans ­were par­tic­u­lar­ly effec­tive in iden­ti­fy­ing the ­source of ­leaks. On the oth­er ­hand CT scan­ning was ­more effec­tive in iden­ti­fy­ing reduc­tions in aneu­rysm diam­e­ter (­itself an indi­ca­tor of the exclu­sion of the aneu­rysm). However all ­these ­results are pre­lim­i­nary and ­demand fur­ther ­study.

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