Contrast-Enhanced ultrasound in endovascular aneurysm repair follow-Up: Our experience

Background: Endovascular aneurysm repair (EVAR) is actually the most common surgical technique used in the treatment of abdominal aortic aneurysm (AAA), worldwide. In EVAR, as we know, the most common complication is endoleak (EL), which is the most common cause of failure in the endovascular treatment of AAA. We can deduce that the surveillance and mid-term/long-term follow-up is mandatory and very important to detect EL. Contrast-enhanced ultrasound (CEUS) has been proposed as the gold standard in EVAR follow-up because its ability to detect EL (especially if they are at low flow like type II) and because it is a cheap technique, reducing direct costs and X-ray exposure to the patients. Methods: We started using CEUS as the first-level examination to detect EL in every EVAR patients. CEUS is performed at 3–6–12 months after EVAR and then annually. Computed tomography scan is performed to every patient, to confirm the diagnosis of EL and in any case of sac enlargement without evidence of EL during CEUS. The procedure consists in the administration of 2.5 ml SonoVue® (Bracco Farmaceutici-Milano) bolus followed by 5 ml sodium chloride 0.9% and is performed on Philips IU22 (Philips, Netherlands). We used to start collecting time at the end of the bolus injection. Results: In our 31 patient population, we recorded 13 cases of EL (41.93%), in particular, 3 cases of type I-III (9.68%) and 10 cases of type II (32.25%); in the whole group, sensibility and specificity (Se and Sp) of CEUS to detect EL (not type-specific) were 92% and 100%, respectively. These data are as other data of more important case-series. Conclusions: CEUS is considered the gold standard technique to detect early EL for more authors worldwide. In our experience, we can confirm this matter because CEUS has high Se and Sp (about 100%, in any cases).