Bredahl K K, Taudorf M, Lönn L, Vogt K C, Sillesen H, Eiberg J P
Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Interventional Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur J Vasc Endovasc Surg. 2016 Dec;52(6):729-734. doi: 10.1016/j.ejvs.2016.07.007. Epub 2016 Oct 17.
OBJECTIVE/BACKGROUND: Surveillance after endovascular aortic aneurysm repair (EVAR) is mandatory and computed tomography angiography (CTA) is considered the standard imaging modality, although patients are exposed to ionizing radiation and nephrotoxic contrast medium. The primary aim of this study was to determine the diagnostic efficacy of duplex ultrasound (DUS) and contrast enhanced ultrasound (CEUS) using CTA as the gold standard. The secondary aim was to determine the clinical consequences of endoleaks missed by DUS and CEUS, or CTA.
All patients with EVAR for an aorto-iliac aneurysm between 1 August 2011 and 31 October 2014 were prospectively and consecutively enrolled. CEUS was added to the existing surveillance protocol, which included DUS, plain abdominal X-ray, and CTA at 3 and 12 months after stent implantation.
In 278 patients, endoleaks were detected in 68, 69, and 46 cases by CTA, CEUS, and DUS, respectively. The sensitivity and specificity of DUS and CEUS were 46% and 93%, and 85% and 95%, respectively. CEUS and CTA were diagnostically equivalent, as opposed to DUS and CTA (p = .002). Endoleaks detected by CTA led to re-intervention in 11 (4%) patients. These endoleaks were also detected by CEUS; however, three out of 11 patients were missed by DUS and underwent re-intervention: limb extension, re-cuff, and attempt to coil lumbar leaks. Endoleaks missed by CEUS or CTA were type II endoleaks without sac expansion.
In surveillance programs after EVAR a diagnostic CEUS examination may replace CTA.
目的/背景：血管内主动脉瘤修复术（EVAR）后监测必不可少，计算机断层扫描血管造影（CTA）被视为标准成像方式，尽管患者会受到电离辐射和肾毒性造影剂的影响。本研究的主要目的是以CTA作为金标准，确定双功超声（DUS）和超声造影（CEUS）的诊断效能。次要目的是确定DUS、CEUS或CTA漏诊内漏的临床后果。
前瞻性连续纳入2011年8月1日至2014年10月31日期间因主-髂动脉瘤接受EVAR治疗的所有患者。在现有的监测方案中增加了CEUS，该方案包括DUS、腹部平片以及支架植入后3个月和12个月的CTA。
278例患者中，CTA、CEUS和DUS分别检测到68例、69例和46例内漏。DUS和CEUS的敏感性和特异性分别为46%和93%，以及85%和95%。与DUS和CTA不同，CEUS和CTA在诊断上等效（p = 0.002）。CTA检测到的内漏导致11例（4%）患者再次干预。这些内漏也被CEUS检测到；然而，11例患者中有3例被DUS漏诊并接受了再次干预：肢体延长、重新置入袖套以及尝试栓塞腰部漏血。CEUS或CTA漏诊的内漏为无瘤腔扩大的II型内漏。
在EVAR后的监测方案中，诊断性CEUS检查可替代CTA。
