Key result
Automated carbon dioxide angiography detected type II endoleaks in 33% of patients compared to 5% with iodinated contrast, showing substantial agreement with CEUS (Cohen's K 0.65).
Why the study?
Does automated carbon dioxide angiography improve the detection of type II endoleaks compared to iodinated contrast media angiography in patients undergoing EVAR?
Observational (n=21)
Single-blind
Does automated carbon dioxide angiography improve the detection of type II endoleaks compared to iodinated contrast media angiography in patients undergoing EVAR?
Automated carbon dioxide angiography demonstrates higher agreement with contrast-enhanced ultrasound for detecting type II endoleaks after EVAR compared to standard iodinated contrast angiography.
May improve intraprocedural low-flow ELII detection over ICM-A; leaves open larger prospective validation versus CEUS.
Introduction . Iodinated contrast media completion angiography (ICM-A) may underestimate the presence of type II endoleak (ELII) after endovascular aortic repair (EVAR), particularly if they are at low flow. Contrast-enhanced ultrasound (CEUS) has been proposed as the gold standard in ELII detection during EVAR follow-up. Intraprocedural carbon dioxide (CO 2 ) angiography has been shown to be useful in this setting; however no comparative studies including these three techniques are currently available. Our aim was to investigate the accuracy of a new automated CO 2 angiographic (CO 2 -A) system in the detection of ELII, by comparing it with ICM-A and CEUS. Methods . A series of consecutive patients undergoing EVAR for abdominal aortic aneurysm (AAA) were enrolled and submitted to ICM-A and CO 2 -A during the procedure. The iodinated contrast media were delivered through an automatic injector connected to a pigtail catheter in the suprarenal aorta. CO 2 was delivered through a recently available automatic injector connected to a 10 F sheath positioned in the external iliac artery. All patients were blindly evaluated by CEUS within postoperative day 1. The ICM-A and CO 2 -A ability to detect ELII was compared with that of CEUS through Cohen’s concordance Index ( K ) . Results . Twenty-one patients were enrolled in the study. One (5%), seven (33%), and four (19%) ELII were detected by ICM-A, CO 2 -A, and CEUS, respectively. The only ELII detected by ICM-A was also detected by CO 2 -A and CEUS. Three cases of ELII detected by CO 2 -A were not detected by CEUS. All ELII detected by CEUS were visualized by CO 2 -A. CEUS and ICM-A showed a poor agreement (Cohen’s K : 0.35) while CEUS and CO 2 -A showed a substantial agreement (Cohen’s K : 0.65) for ELII detection. Conclusion . CO 2 -A is safe and effective method for ELII detection in EVAR, with a significantly higher agreement with CEUS if compared with ICM-A. This trial is registered with 155/2015/U/Oss.
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Mascoli et al. (2018) conducted an observational in Abdominal aortic aneurysm (AAA) undergoing EVAR (n=21). Automated carbon dioxide angiography (CO2-A) vs. Iodinated contrast media completion angiography (ICM-A) and contrast-enhanced ultrasound (CEUS) was evaluated on Detection of type II endoleak (ELII) (Cohen's K 0.65 (vs CEUS)). Automated carbon dioxide angiography detected type II endoleaks in 33% of patients compared to 5% with iodinated contrast, showing substantial agreement with CEUS (Cohen's K 0.65).
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