Most Type II Leaks Missed By Ultrasound Not Serious

By Hank Russell

NEW YORK -- Color ultrasound is less likely to detect type II, compared with type I, endoleaks, but the majority of those missed sealed spontaneously, according to Dr. Ali AbuRahma at the Veith symposium on vascular medicine sponsored by the Cleveland Clinic.

Dr. AbuRahma discussed his findings on the fate of these endoleaks in patients who underwent endovascular repair. He compared type I and type II endoleaks detected using computed tomography with those that were detected by color ultrasound

In the past, Dr. AbuRahma had compared the use of CT with that of color-coded duplex ultrasonography, but this year's presentation, he said, was different. "This year, it is about what is the fate of the endoleak which we missed by ultrasound and what we see by a CT scan," said Dr. AbuRahma of the Charleston (W.Va.) Area Medical Center.

In his study, 232 patients were followed, of which approximately 16% had an endoleak. Of the 30 that had an early endoleak, 12 had a type I endoleak and 16 had a type II endoleak. Of the nine that had a late endoleak, six had a type I endoleak and three had a type II endoleak.

"For the type I endoleak, 16 out of 18 (89%) detected by CTA were confirmed by color ultrasound," Dr. AbuRahma said, "however, only 11 out of 19 (58%) of type II endoleaks were confirmed by color ultrasound."

In determining the fate of the endoleaks, 18 type I endoleaks were detected by CT scan and 16 by color ultrasound. Of those, 12 were early endoleaks. Nine of the 12 sealed spontaneously and 3 persisted.

Of the three that persisted, "two were treated with proximal cuffs because the size of the [aneurysm] sac was increasing," Dr. AbuRahma said. "One was observed because the sac hadn't changed."

Of the six late type I endoleaks, four were treated with extension cuffs because of the increasing sac size, one was observed because the sac was stable and one refused treatment. "The patient didn't want anything to be done at all," he explained.

Of the two type I endoleaks missed by ultrasound, one needed proximal cuffs and one was observed. "In summary, only one needed treatment," he said.

Eleven of the 19 type II endoleaks were detected by ultrasound, as Dr. AbuRahma previously mentioned, but 16 of the 19 were early endoleaks. Fifteen of them sealed spontaneously and one persisted. The remaining 3 of the 16 type II endoleaks were late endoleaks--2 were simply observed and 1 was treated with coils.

"What happened specifically to the missed type II endoleaks?" Dr. AbuRahma said, "There were 8 of 19 missed by ultrasound; 6 were early endoleaks, which resolved spontaneously; 2 were late endoleaks, 1 of which was treated with a coil and the other was observed."

Dr. AbuRahma made this recommendation. "Color ultrasound has lower sensitivity in detecting endoleaks, particularly in type II endoleaks," he said.

"Intervention can be offered for type II if there is an increase in aneurysm sac size."