Schaeffer Jacob S, Shakhnovich Irina, Sieck Kyle N, Kallies Kara J, Davis Clark A, Cogbill Thomas H
1 General Surgery Residency, Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
2 Department of General and Vascular Surgery, Gundersen Health System, La Crosse, WI, USA.
Vasc Endovascular Surg. 2017 Jul;51(5):295-300. doi: 10.1177/1538574417708131. Epub 2017 May 23.
Health-care costs and risks of radiation and intravenous contrast exposure challenge computed tomography angiography (CTA) as the standard surveillance method after endovascular abdominal aortic aneurysm repair (EVAR). We reviewed our experience using Duplex ultrasound scan (DUS) as an initial and subsequent surveillance technique after uncomplicated EVAR.
The medical records of patients who underwent EVAR from 2004 to 2014 with at least 1 postoperative imaging study were retrospectively reviewed. Duplex ultrasound scan was the primary modality, with CTA reserved for patients with suspicious findings.
Mean follow-up was 3.2 years for 266 patients. Fifty-seven endoleaks (7 type I, 50 type II) were detected in 51 patients (19%). Nineteen (33%) endoleaks were identified and monitored by DUS alone. Nine (16%) endoleaks were identified on CTA without prior DUS. Twenty-two (39%) endoleaks were identified on DUS and confirmed by CTA; 6 of these patients had a secondary intervention. When compared to subsequent CTA, there were 7 discordant results: 4 false-negative and 3 false-positive endoleaks on DUS. Two of these patients with discordant results required intervention. Follow-up CTA was not obtained for the other 2 patients due to severe comorbidities including renal disease. One of these patients eventually developed abdominal aortic aneurysm rupture and death. Among 88 patients with both DUS and CTA, positive predictive value and negative predictive value for DUS were 0.88 and 0.94, respectively. Sac size on DUS compared to CTA resulted in an interclass correlation coefficient of r = .84.
In our experience, DUS was safe and effective for initial and follow-up surveillance after uncomplicated EVAR.
医疗成本以及辐射和静脉注射造影剂暴露的风险对计算机断层血管造影（CTA）作为血管内腹主动脉瘤修复术（EVAR）后标准监测方法提出了挑战。我们回顾了我们将双功超声扫描（DUS）用作单纯性EVAR术后初始及后续监测技术的经验。
对2004年至2014年接受EVAR且至少有1次术后影像学检查的患者的病历进行回顾性分析。双功超声扫描是主要方式，CTA用于有可疑发现的患者。
266例患者的平均随访时间为3.2年。51例患者（19%）检测到57处内漏（7处I型，50处II型）。19处（33%）内漏仅通过DUS发现并监测。9处（16%）内漏在未先行DUS检查的情况下通过CTA发现。22处（39%）内漏通过DUS发现并经CTA证实；其中6例患者接受了二次干预。与后续CTA相比，有7个结果不一致：DUS检查有4例假阴性和3例假阳性内漏。这7例结果不一致的患者中有2例需要干预。另外2例患者因包括肾病在内的严重合并症未进行后续CTA检查。其中1例患者最终发生腹主动脉瘤破裂并死亡。在88例同时接受DUS和CTA检查的患者中，DUS的阳性预测值和阴性预测值分别为0.88和0.94。DUS与CTA测量的瘤体大小的组内相关系数为r = 0.84。
根据我们的经验，DUS对于单纯性EVAR术后的初始及随访监测是安全有效的。
