Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair

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Presentation transcript:

Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair Roberto Iezzi, MD, Raffaella Basilico, MD, Daniela Giancristofaro, MD, Danilo Pascali, MD, Antonio Raffaele Cotroneo, MD, Maria Luigia Storto, MD Journal of Vascular Surgery Volume 49, Issue 3, Pages 552-560 (March 2009) DOI: 10.1016/j.jvs.2008.10.008 Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 1 A 74-year-old man treated with endovascular aneurysm repair (6-month follow-up). a, A large endoleak was correctly detected on color duplex ultrasound imaging and (b) contrast-enhanced ultrasound images, and (c) was confirmed by standard of reference. Journal of Vascular Surgery 2009 49, 552-560DOI: (10.1016/j.jvs.2008.10.008) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 2 An 82-year-old man treated with endovascular aneurysm repair at 1-month follow-up. a, The baseline color duplex ultrasound image did not demonstrate any color duplex signal beyond the graft, with a consequent negative diagnosis for endoleak. b, The contrast-enhanced ultrasound image showed a small endoleak (arrows) at 150 seconds after contrast injection which was regarded as a low-flow leak. c and d, Standard of reference confirmed the presence of a small endoleak on the posterolateral side of the aneurysm, detected only on delayed phase axial CT image (low-flow leak) (arrows in panel d). Journal of Vascular Surgery 2009 49, 552-560DOI: (10.1016/j.jvs.2008.10.008) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 3 A 78-year-old woman treated with endovascular aneurysm repair at the 12-month follow-up. a, A contrast-enhanced ultrasound image shows a high attenuation area outside the graft (arrows) but within the aneurysm sac, and an endoleak was diagnosed. b, However, no endoleak was detected on axial arterial and (c) delayed-phase computed tomography images. d, An accurate evaluation of the baseline color duplex ultrasound image allows the recognition of a high attenuation of the thrombus outside the stent graft lumen (arrows) excluding the previous false-positive endoleak. Journal of Vascular Surgery 2009 49, 552-560DOI: (10.1016/j.jvs.2008.10.008) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 4 Qualitative evaluation of endoprosthesis visualization scores for color duplex (gray bars), and contrast-enhanced ultrasound imaging (CEUS) with 1.2 mL (diagonal-patterned bars) and 2.4 mL (dark gray). An, Anastomosis; Br, branch; Prox, proximal. Journal of Vascular Surgery 2009 49, 552-560DOI: (10.1016/j.jvs.2008.10.008) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 5 A 71-year-old man treated with endovascular aneurysm repair at the 1-month follow-up. A large endoleak located in a posterolateral position was shown on the (a, c) three-dimensional and (b) axial computed tomography images, associated with (c) opacification of a lumbar artery, classified as a type II endoleak. However, the leak was also strictly adjacent to the prosthesis, with a consequent possible diagnosis of a concomitant type III endoleak. A classification of the endoleak was not clearly performed on the basis of the computed tomography images. d, An evaluation of dynamic contrast-enhanced ultrasound images demonstrated the back-filling of the excluded aneurysmal sac via lumbar artery, excluding a concomitant type III endoleak, as confirmed by digital subtraction angiography (e-g, arrows in f and asterisk in g). Journal of Vascular Surgery 2009 49, 552-560DOI: (10.1016/j.jvs.2008.10.008) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions