The Usefulness of Contrast-Enhanced Ultrasound for Surveillance of Endoleak after Endo-vascular Aneurysm Repair

Purpose: Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open repair for patients with abdominal aortic aneurysm (AAA). Yet the follow-up after EVAR with lifelong post-interventional imaging is mandatory in order to detect complications such as endoleaks or stent migration. Computed tomography angiography (CTA) is considered the standard imaging modality and widely used for follow-up, although patients are exposed to both radiation and nephrotoxic contrast medium. The aim of this study was to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) for detecting post EVAR endoleaks compared with that of CTA, which is considered as the gold standard. Methods: From January 2010 to August 2019, 27 patients who underwent CEUS and CTA for follow-up after elective EVAR at a single center were retrospectively analyzed. The presence of endoleak was compared between CTA and CEUS. Results: The 27 paired CTA and CEUS studies were analyzed. Eleven patients had endoleak detected on CEUS and they had the same findings with CTA. One patient had endoleak detected on CEUS, but this was not detected on CTA. Three patients didn’t have endoleak detected on CEUS, but endoleak was detected on CTA. 13 patients had no endoleak detected on CEUS or CTA. Assuming CTA is the gold standard, the sensitivity and specificity of CEUS to detect endoleak were 92.3%, and 78.6% respectively. Conclusion: CEUS can be used as a viable and feasible imaging alternative for the follow-up and the detection of endoleak after EVAR with the additional benefit of being a real-time non-ionizing radiation examination.