Liverpool Vascular and Endovacular Service (LiVES), Royal Liverpool University Hospital, Liverpool, United Kingdom.
J Vasc Surg. 2013 Jul;58(1):18-23. doi: 10.1016/j.jvs.2012.12.057. Epub 2013 Mar 13.
Endovascular aneurysm repair (EVAR) surveillance includes duplex ultrasound, abdominal radiography, and computed tomography angiography. Contrast-enhanced ultrasound (CEUS) has emerged as an additional modality whose role remains undefined. We evaluated whether a potential role for CEUS was the elucidation of unresolved issues following standard surveillance modalities.
All patients undergoing EVAR at a tertiary referral center had surveillance based on plain abdominal radiograph and duplex ultrasound, with single arterial phase computed tomography angiography reserved for abnormalities or nondiagnostic imaging. In this prospective evaluation, from April 2010 to July 2011, discordance between imaging modalities or unresolved surveillance issues prompted CEUS. Cases and imaging were discussed in a multidisciplinary setting and outcomes recorded.
During the study period, 539 patients underwent EVAR surveillance, of whom 33 (6%) had CEUS for unresolved issues (median age, 79; range, 66-90; 28 male). Median follow-up after EVAR was 23 months (range, 0-132). In all cases, CEUS was able to resolve the clinical issue, resulting in secondary intervention in 10 patients (30%). The remaining patients were returned to surveillance. Within the cohort of 33 patients, the clinical issues were categorized into three groups. Group 1: Endoleak of uncertain classification (n = 27: 21 type II, four type I, two had endoleak excluded). Group 2: Significant aneurysm expansion (≥ 5 mm) without apparent endoleak (n = 4: one type II, three had endoleak excluded). Group 3: Target vessel patency following fenestrated EVAR (n = 2: patency confirmed in both).
CEUS can enhance EVAR surveillance through clarification of endoleak and target vessel patency when standard imaging modalities are not diagnostic.
血管内动脉瘤修复术（EVAR）的监测包括双功能超声、腹部 X 射线摄影和计算机断层血管造影术。对比增强超声（CEUS）已成为一种新的检查方法，但它的作用尚未明确。我们评估了 CEUS 是否可以通过阐明标准监测方法后仍未解决的问题来发挥作用。
在一家三级转诊中心，所有接受 EVAR 的患者均根据普通腹部 X 射线和双功能超声进行监测，仅在存在异常或影像学检查不可诊断的情况下，才进行单动脉期计算机断层血管造影术。在这项前瞻性评估中，我们从 2010 年 4 月至 2011 年 7 月，当影像学方法之间存在差异或监测存在未解决的问题时，会进行 CEUS。在多学科环境中讨论病例和影像学，并记录结果。
在研究期间，539 例患者接受了 EVAR 监测，其中 33 例（6%）因未解决的问题而进行了 CEUS（中位年龄 79 岁；范围，66-90 岁；28 例男性）。EVAR 后中位随访时间为 23 个月（范围，0-132 个月）。在所有情况下，CEUS 都能够解决临床问题，导致 10 例患者（30%）进行了二次干预。其余患者返回监测。在 33 例患者的队列中，临床问题分为三组。第 1 组：不确定分类的内漏（27 例：21 型 II 型，4 型 I 型，2 例排除内漏）。第 2 组：明显的动脉瘤扩张（≥5 毫米）而无明显内漏（4 例：2 型 II 型，3 例排除内漏）。第 3 组：开窗 EVAR 后的靶血管通畅性（2 例：均证实通畅）。
CEUS 可以通过阐明标准影像学检查不可诊断的内漏和靶血管通畅性来增强 EVAR 的监测。
