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Home > Vascular Annual Meeting > manning_duplex_ultrasonography

Duplex Ultrasonography in Aneurysm Surveillance Following Endovascular Aneurysm Repair: A Comparison with CT Aortography

Brian J. Manning, Sean O'Neill, Naseem Haider, Pedro deAlmeida, Colette Fahy, Graham Wilson, Mary Paula Colgan, Gregor Shanik, Prakash Madhavan, Dermot Moore.
St. James's Hospital, Dublin, Ireland.
 
OBJECTIVES: Cumulative radiation dose, cost and increased demand for CT Aortography (CTA) suggest that Duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up.

METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleaks detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa.

RESULTS: 140 patients underwent EVAR, of whom 119 attended for follow-up ranging from 6 months to 9 years (mean 32 months). Adequate aneurysm sac visualization on DU was not possible in 2% of patients, predominantly due to obesity. 27 endoleaks were detected in 27 patients during follow-up. Of these, 22 were initially identified on DU (5 false negative DU examinations). 21 endoleaks were type II in nature and 1 patient had increased sac size. There were 2 Type I endoleaks and 4 Type III endoleaks. 2 of these (both Type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5mm or more at follow-up, 4 had an endoleak visible on DU, yet negative CTA and a further 4 had endoleak visualization on both DU and CTA. Of 6 endoleaks which underwent re-intervention, all were initially picked up on DU. 1 of these endoleaks was never demonstrated on CTA and a further 2 had at least one negative CTA prior to endoleak confirmation. Specificity of DU for endoleak detection was 50% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 92.5%, with all clinically significant endoleaks demonstrated on CTA also detected on DU.

CONCLUSIONS: Despite its low positive predictive value, we found DU to be a sensitive test for the detection of clinically significant endoleaks. Given concerns about cumulative radiation exposure and cost, and the surprisingly low sensitivity of CTA for endoleak detection in this series, selective CTA based on DU surveillance may be a more appropriate long-term strategy.

AUTHOR DISCLOSURES: B.J. Manning, None; S. O'Neill, None; N. Haider, None; P. deAlmeida, None; C. Fahy, None; G. Wilson, None; M. Colgan, None; G. Shanik, None; P. Madhavan, None; D. Moore, None.