Utilization of intraoperative contrast-enhanced ultrasound in the treatment of complex endoleaks

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Clinically significant complex endoleaks following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (n=3). Intervention: Intraoperative contrast-enhanced ultrasound (CEUS) with sulfur hexafluoride microbubbles (Lumason). Primary outcome: Successful intraoperative localization and exclusion/resolution of endoleak with aneurysm sac stabilization or reduction.

Mackenzie Snyder; Hannah L. Pambianchi; Megan J. Lenihan; David J. Spinosa; Kendal M. Endicott

doi:10.1016/j.jvscit.2025.101882

June 17, 2025Journal of Vascular Surgery Cases and Innovative TechniquesOpen Access

Utilization of intraoperative contrast-enhanced ultrasound in the treatment of complex endoleaks

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Key result

Intraoperative CEUS achieves 100% success in localizing and excluding complex endoleaks while minimizing contrast.

n=3

Why the study?

Intraoperative visualization of abdominal aortic endograft endoleaks can be challenging on two-dimensional fluoroscopy and during anesthesia-related hypotension, motivating the evaluation of contrast-enhanced ultrasound to guide complex endoleak repair.

Does intraoperative contrast-enhanced ultrasound (CEUS) facilitate localization and confirm successful exclusion of complex endoleaks in patients with prior EVAR?

Study Design

Type

Case Report (n=3)

Multicenter

No

Structured PICO

Does intraoperative contrast-enhanced ultrasound (CEUS) facilitate localization and confirm successful exclusion of complex endoleaks in patients with prior EVAR?

P

Population

3 older male patients (aged 71-85 years) with clinically significant type II or type III endoleaks following endovascular abdominal aortic aneurysm repair, including 2 with chronic kidney disease and 1 with contained sac rupture.

I

Intervention

Intraoperative contrast-enhanced ultrasound (CEUS) using a 2-mL peripheral intravenous bolus of sulfur hexafluoride microbubbles (Lumason) and a curved 1-7 MHz probe to localize endoleaks, guide direct sac puncture or graft relining/cuff placement and coil embolization, and confirm treatment success in real time.

O

Outcome

Intraoperative visualization and confirmation of endoleak exclusion/resolution on postoperative imaging (CTA or repeat CEUS on POD #1, POD #4, and 1 month)surrogate

Limitations

Small case series of 3 patients
Operator-dependent technique with a learning curve requiring an experienced operator and in-depth clinical knowledge
More labor-intensive than standard intraoperative imaging
Injection of air into the aneurysm sac during endovascular procedures obscures visibility with CEUS
Reduced sensitivity for detecting endoleaks in obese patients
Operator-dependent modality requiring an experienced operator and in-depth clinical knowledge
Learning curve in exam interpretation and potential bias from prior CTA results
More labor-intensive approach
Air injected into the aneurysm sac during endovascular procedures obscures CEUS visibility
Lower sensitivity for endoleak detection in obese patients

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Implication

Intraoperative contrast-enhanced ultrasound provides real-time localization and confirmation of complex EVAR endoleak exclusion, guiding targeted endovascular repair while minimizing nephrotoxic iodinated contrast use.

Abstract

Contrast-enhanced ultrasound (CEUS) is an imaging adjunct utilized at select centers for the detection of occult abdominal aortic endograft endoleaks. This report details three cases utilizing intraoperative CEUS to aid in the treatment of clinically significant endoleaks. In particular, CEUS provided real-time feedback regarding treatment success. This approach also allowed for minimalization of iodinated contrast in a patient with advanced renal disease and localization to guide direct needle puncture. CEUS is a powerful imaging modality that can aid in the identification and treatment execution of difficult endoleaks.

Discussion

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Cite This Study

Snyder et al. (2025) conducted a case report in Clinically significant complex endoleaks following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (n=3). Intraoperative contrast-enhanced ultrasound (CEUS) with sulfur hexafluoride microbubbles (Lumason) was evaluated on Successful intraoperative localization and exclusion/resolution of endoleak with aneurysm sac stabilization or reduction. Intraoperative contrast-enhanced ultrasound successfully localized complex type II and III endoleaks and confirmed complete endoleak exclusion in all 3 patients while minimizing iodinated contrast.

synapsesocial.com/papers/6af8db1513da97bebf27efcb https://doi.org/10.1016/j.jvscit.2025.101882

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Utilization of intraoperative contrast-enhanced ultrasound in the treatment of complex endoleaks

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Utilization of intraoperative contrast-enhanced ultrasound in the treatment of complex endoleaks

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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