Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.
Christchurch Clinical School of Medicine, University of Otago, Otago, New Zealand.
J Med Imaging Radiat Oncol. 2022 Dec;66(8):1059-1064. doi: 10.1111/1754-9485.13409. Epub 2022 Apr 10.
In the context of increasingly common endovascular treatment for abdominal aortic aneurysms, endoleak is a relatively common complication of (abdominal) EVAR, and ongoing multimodality surveillance programs are recommended by expert bodies including the Society for Vascular Surgery (SVS). We describe the colour doppler ultrasound (CDUS) finding defined as pseudoendoleak that may be misinterpreted as significant endoleak and may be resolved through the use of contrast-enhanced ultrasound (CEUS).
Retrospective review of cases at our institution identified five cases where apparent endoleak on CDUS was not evident on CEUS, performed immediately following CDUS.
Each of these five cases demonstrated interval increase in sac size at varying intervals post-EVAR, and in 4 out of 5 cases, no endoleak was demonstrated on multiple other modalities, at multiple time points. One case demonstrated an isolated type 2 endoleak at one time point, a finding that could not be reproduced. In each case, index-positive CDUS is thought to represent agitated fluid within the excluded sac that is not in continuity with the arterial blood pool as evidenced by the absence of CEUS enhancement.
In cases of positive post-EVAR CDUS, CEUS is an effective tool to exclude the presence of pseudoendoleak and thus avoid further and potentially invasive diagnostic modalities in an elderly and comorbid cohort.
在腹主动脉瘤的血管内治疗越来越常见的背景下，内漏是（腹）EVAR 的一种相对常见的并发症，包括血管外科学会（SVS）在内的专家机构建议进行多模态的持续监测计划。我们描述了彩色多普勒超声（CDUS）定义的假性内漏的发现，这种发现可能被误诊为明显的内漏，并可能通过使用对比增强超声（CEUS）得到解决。
对我院的病例进行回顾性研究，发现了 5 例 CDUS 上明显的内漏在 CEUS 上不明显的病例，这些病例均在 CDUS 后立即进行了 CEUS。
这 5 例病例中，每个病例在 EVAR 后不同时间间隔的囊腔大小均有不同程度的增加，在 5 例中的 4 例中，在多个时间点，多个其他检查方法均未显示内漏。1 例在一个时间点显示孤立的 2 型内漏，但这一发现无法重现。在每个病例中，阳性的 CDUS 被认为代表了被排除的囊腔内的搅动液体，与动脉血池没有连续性，这一点可以通过 CEUS 增强的缺失来证明。
在 EVAR 后 CDUS 阳性的情况下，CEUS 是一种有效的工具，可以排除假性内漏的存在，从而避免在老年和合并症患者中进一步使用潜在的有创诊断方法。
