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International Angiology 2000 December;19(4):326-30


lingua: Inglese

Colour Doppler diagnosis of perigraft flow following endovascular repair of abdominal aortic aneurysm

Fletcher J., Saker K., Batiste P., Dyer S.

From the Department of Surgery, University of Sydney and Westmead Vascular Laboratory, Westmead, New South Wales, Sydney, Australia


Background. Endovascular ­repair of abdom­i­nal aor­tic aneu­rysm is a rel­a­tive­ly new sur­gi­cal tech­nique which is less inva­sive than con­ven­tion­al open abdom­i­nal sur­gery but is asso­ciat­ed with a sig­nif­i­cant spe­cif­ic com­pli­ca­tion of endo­leak. The aim of this study was to deter­mine the accu­ra­cy of ­duplex ultra­sound imag­ing, util­is­ing ­colour Doppler, as the pri­mary meth­od for post sur­gi­cal mon­i­tor­ing of endo­vas­cu­lar aneu­rysm ­repair.
Methods. Experimental ­design: a case ­cohort study of 45 ­patients under­go­ing endo­vas­cu­lar ­repair of abdom­i­nal aor­tic aneu­rysm. Setting: angio­gra­phy, CT scan­ning and sur­gery per­formed at Westmead Hospital, a teach­ing hos­pi­tal of the University of Sydney; ­patients fol­lowed post­op­er­a­tive­ly at the Westmead Vascular Laboratory, a ded­i­cat­ed vas­cu­lar diag­nos­tic ultra­sound facil­ity. Patients: Forty males and five ­females, mean age 69.1 years (range 51 to 84). Interventions: ­patients under­went attempt­ed inser­tion of an EVT (endo­vas­cu­lar pros­the­sis) for exclu­sion of abdom­i­nal aor­tic aneu­rysm (mean diam­e­ter 5.3 cm; range 4.0 to 8.4 cm). Conversion to open ­repair was ­required in three cases (6.6%). An aorto-­biliac graft was insert­ed in 28 ­patients, a tube graft in eight and an aorto-uni­lat­er­al iliac graft with fem­o­rof­e­mo­ral (or ili­oi­lial) cross­over graft in six. Measures: ­patients were fol­lowed over a peri­od of 53 ­months (­median fol­low-up time 15 ­months) with 106 ­colour Doppler scans of 39 endo­vas­cu­lar ­grafts (mean of 2.9 scans per ­patient).
Results. All aneu­rysms ­decreased in diam­e­ter (range 0.1 cm to 4.3 cm, mean 0.9 cm). Abnormal flow in the resid­u­al aneu­rys­mal sac was found in three ­patients. In all three cases of endo­leak the ­colour Doppler diag­no­sis was sup­port­ed by CT scan and con­firmed on angio­gra­phy. The CT scans did not pro­vide any addi­tion­al infor­ma­tion to that ­obtained by ­colour Doppler imag­ing.
Conclusions. Colour Doppler pro­vides an effec­tive means of non-inva­sive fol­low-up assess­ment of ­patients who have had endo­vas­cu­lar ­repair of abdom­i­nal aor­tic aneu­rysms.

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