Duplex ultrasound scanning is reliable in the detection of endoleak following endovascular aneurysm repair

Department of Cardiovascular Sciences, University of Leicester, Leiscester, England, United Kingdom
European Journal of Vascular and Endovascular Surgery (Impact Factor: 3.07). 12/2006; 32(5):537-41. DOI: 10.1016/j.ejvs.2006.05.013
Source: PubMed

ABSTRACT To investigate the value of duplex ultrasound scanning (DUSS) in the routine follow up of patients following EVAR.
Imaging was reviewed for 310 consecutive patients undergoing EVAR at a single centre. Concurrent ultrasound and CT scans were defined as having occurred within 6 months of each other. There were 244 paired concurrent DUSS and CT scans which were used for further analysis. These modalities were compared with respect to sensitivity, specificity, positive and negative predictive values and level of agreement (by Kappa statistics) using CT as the 'gold standard'.
DUSS failed to detect a number of endoleaks which were seen on CT and the sensitivity of this test was therefore poor (67%). However, the specificity of DUSS compared more favourably with a value of 91%. Positive predictive values ranged from 33-100% but negative predictive values were more reliable with values of 91-100% at all time points post operatively. There were no type I leaks, or endoleaks requiring intervention which were missed on DUSS. Overall, there was a 'fair' level of agreement between the two imaging modalities using Kappa statistics.
Although DUSS is not as sensitive as CT scanning in the detection of endoleak, no leaks requiring intervention were missed on DUSS in this study. DUSS is much cheaper than CT and avoids high doses of radiation. DUSS therefore remains a valuable method of follow up after EVAR and can reduce the need for repeated CT scans.

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    ABSTRACT: Type II endoleaks (EFII) are related to retrograde flow via aorta tributaries. They are the most frequent complication after endovascular aneurysm repair (EVAR). We hypothesized that the use of contrast-enhanced ultrasound (CEUS) by an experienced vascular physician could increase the sensitivity of detecting EFII compared with computed tomography angiography (CTA) taken as the gold standard. From November 2010 to February 2013, patients with EVAR were included prospectively. All patients had a color duplex ultrasound (CDU), CEUS and CTA. Sensitivity, specificity and kappa's coefficient were determined to estimate the performance of CDU and CEUS to assess EFII compared with CTA. Sixty CDU and 60 CEUS explorations were compared to 60 CTA explorations. Nineteen type EFII were detected by CTA, 14 by CDU and 15 by CEUS. CDU sensitivity was 74% (κ=0.75), and CEUS sensitivity was 78% (κ=0.8). Both tests exhibited 97% specificity. There was good agreement between CDU results (κ=0.75) and CEUS results (κ=0.8) compared with CTA. There was very good agreement between CDU and CEUS results for detection of EFII (κ=0.93). There was no statistically significant difference between the sensitivity of CDU and CEUS (P=0.32). Our results suggest that contrast enhancement does not increase yield for ultrasound detection of type II endoleaks when performed by an experienced vascular physician.
    Journal des Maladies Vasculaires 10/2013; · 0.24 Impact Factor
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    ABSTRACT: Background:Previous analyses suggested that duplex ultrasonography (DUS) detected endoleaks after endovascular aneurysm repair (EVAR) with insufficient sensitivity; they did not specifically examine types 1 and 3 endoleak, which, if untreated, may lead to aneurysm-related death. In light of changes to clinical practice, the diagnostic accuracy of DUS and contrast-enhanced ultrasonography (CEUS) for types 1 and 3 endoleak required focused reappraisal. Methods:Studies comparing DUS or CEUS with computed tomography (CT) for endoleak detection were identified. CT was taken as the standard in bivariable meta-analysis. Results:Twenty-five studies (3975 paired scans) compared DUS with CT for all endoleaks. The pooled sensitivity was 0·74 (95 per cent confidence interval 0·62 to 0·83) and the pooled specificity was 0·94 (0·90 to 0·97). Thirteen studies (2650 paired scans) reported detection of types 1 and 3 endoleak by DUS; the pooled sensitivity of DUS was 0·83 (0·40 to 0·97) and the pooled specificity was 1·00 (0·97 to 1·00). Eleven studies (961 paired scans) compared CEUS with CT for all endoleaks. The pooled sensitivity of CEUS was 0·96 (0·85 to 0·99) and the pooled specificity was 0·85 (0·76 to 0·92). Eight studies (887 paired scans) reported detection of types 1 and 3 endoleak by CEUS. The pooled sensitivity of CEUS was 0·99 (0·25 to 1·00) and the pooled specificity was 1·00 (0·98 to 1·00). Conclusion:Both CEUS and DUS were specific for detection of types 1 and 3 endoleak. Estimates of their sensitivity were uncertain but there was no evidence of a clinically important difference. DUS detects types 1 and 3 endoleak with sufficient accuracy for surveillance after EVAR. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
    British Journal of Surgery 11/2012; 99(11). DOI:10.1002/bjs.8873 · 5.21 Impact Factor
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    ABSTRACT: Aim-Background We aim to give a conceptual description of the differences between open and endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) which represents a significant problem due to the risk of rupture and its high death rates. Additionally, we underline and discuss the current debates referring to each approach. Methods The MEDLINE/PubMed database was searched for publications with the medical subject heading “Ruptured abdominal aortic aneurysms (RAAA)” and keywords “EVAR” or “open repair” or “eEVAR” or ” randomized controlled trials“. The search was conducted both on the basis of the MESH tree and as a text search. We restricted our search to English publications up to July 2010. Results A total of 243 studies were identified, 78 of which were eventually deemed relevant to this review. Conclusions Patients who are suitable for this method are high-risk patients with suitable anatomy, and patients with suitable anatomy who expressed a preference for the method. The selection of patients for eEVAR is heavily debated, as far as factors like haemodynamic instability, imaging procedures, logistic issues and anatomical suitability are concerned. The “freer” the indications are for its application, the likelier the procedure is to present problems or failures which can lead to the process becoming challenged and restrained.
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 11/2013; 84(6). DOI:10.1007/s13126-012-0059-0

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