| 8. Truijers M, Resch T, Van Den Berg JC, Blankensteijn JD, Lonn L. Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance. [Review] [69 refs]. J Cardiovasc Surg (Torino). 50(4):423-38, 2009 Aug. |
Review/Other-Dx |
N/A |
To discuss the benefits of EVAR. |
Up-to-date knowledge of noninvasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects. |
4 |
| 9. AbuRahma AF, Campbell J, Stone PA, et al. The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients. J Vasc Surg. 2009; 50(4):738-748. |
Observational-Dx |
238 patients |
To analyze the correlation of aortic neck length to early and late outcomes. |
The mean follow-up was 24.7 months (range, 1-87 months). The initial technical success was 99%. The perioperative complication rates for groups L1, L2, and L3 were 13%, 21%, and 24%, respectively (P = .289). Proximal type I early endoleaks occurred in 12%, 42%, and 53% in groups L1, L2, and L3, respectively (P < .001). Intraoperative proximal aortic cuffs were needed to seal proximal type I endoleaks in 10%, 38%, and 47% in L1, L2, and L3 groups, respectively (P < .0001). However, the rate of late reintervention was comparable in all groups. Postoperatively, the size of the abdominal aortic aneurysm decreased or remained unchanged in 95%, 94%, and 88% in L1, L2, and L3, respectively (P = .660). Rates of freedom from late type I endoleak at 1, 2, and 3 years were 84%, 82%, and 80% for L1; 68%, 54%, and 54% for L2; and 71%, 71%, and 53% for L3 (P = .0263). Rates of freedom from late intervention at 1, 2, and 3 years were 96%, 94%, and 92% for L1; and 94%, 83%, and 83% for L2; and 93%, 93%, and 93% for L3 (P = .5334). EVAR can be used for patients with a short aortic neck; however, it was associated with a significantly higher rate of early and late type I endoleaks, resulting in an increased use of proximal aortic cuffs for sealing the endoleaks. |
3 |
| 12. Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008; 358(5):464-474. |
Observational-Tx |
22,830 matched patients |
To evaluate perioperative rates of death and complications, long-term survival, rupture, and reinterventions after open repair as compared with EVAR of AAA in propensity-score-matched cohorts of Medicare beneficiaries undergoing repair during the 2001-2004 period, with follow-up until 2005. |
Perioperative mortality was lower after endovascular repair than after open repair (1.2% vs 4.8%, P<0.001). Late survival was similar in the two cohorts, although the survival curves did not converge until after 3 years. By 4 years, surgery for laparotomy-related complications was more likely among patients who had undergone open repair (9.7%, vs 4.1% among those who had undergone EVAR; P<0.001), as was hospitalization without surgery for bowel obstruction or abdominal-wall hernia (14.2% vs 8.1%, P<0.001). As compared with open repair, EVAR is associated with lower short-term rates of death and complications. The survival advantage is more durable among older patients. Late reinterventions related to AAA are more common after EVAR but are balanced by an increase in laparotomy-related reinterventions and hospitalizations after open surgery. |
2 |
| 14. Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 123(24):2848-55, 2011 Jun 21.Circulation. 123(24):2848-55, 2011 Jun 21. |
Observational-Dx |
10,228 total patients |
To evaluate compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. |
59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age >/= 80 years, aortic neck diameter >/= 28 mm, aortic neck angle >60 degrees , and common iliac artery diameter >20 mm. In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture. |
4 |
| 15. Ronsivalle S, Faresin F, Franz F, Rettore C, Zanchetta M, Olivieri A. Aneurysm sac "thrombization" and stabilization in EVAR: a technique to reduce the risk of type II endoleak. J Endovasc Ther. 2010; 17(4):517-524. |
Observational-Tx |
404 patients |
To evaluate the reduction in type II endoleak risk after introducing a new prevention method, "thrombization" or clotting of the aneurysm sac, during endovascular aneurysm repair (EVAR) versus the standard EVAR technique. |
The 2 treatment groups were similar with regard to aneurysm morphology. No allergic or anaphylactic reactions were encountered related to the fibrin glue. Over median follow-up times of 72 months in group 1 and 26 months in group 2, there were 34 (15.2%) endoleaks in group 1 versus 4 (2.2%) in group 2 (p<0.0001). The incidence of type II endoleak was 0.25/100 person-months for group 1 versus 0.07/100 person-months for group 2. The preventive sac thrombization technique was significantly associated with a reduced risk of type II endoleak (HR 0.13, 95% CI 0.05 to 0.36; p<0.0001) regardless of the type of stent-graft fixation (infrarenal versus suprarenal). |
2 |
| 16. Brewster DC, Jones JE, Chung TK, et al. Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade. Ann Surg. 2006; 244(3):426-438. |
Observational-Tx |
873 patients |
To evaluate a 12-year experience with EVAR to document late outcomes. |
Mean follow up was 27 months. 39.3% of patients had 2 or more major comorbidities, and 19.5% would be categorized as unfit for open repair. Thirty-day mortality was 1.8%. By Kaplan-Meier analysis, freedom from AAA rupture was 97.6% at 5 years and 94% at 9 years. Significant predictors of reintervention included use of first-generation devices (OR, 1.2; P<0.01) and late onset endoleak (OR, 64; P<0.001). Current generation stent grafts correlated with significantly improved outcomes. Cumulative freedom from conversion to open repair was 93.3% at 5 through 9 years, with the need for prior reintervention (OR, 16.7; P=0.001) its most important predictor. EVAR using contemporary devices is a safe, effective, and durable method to prevent AAA rupture and aneurysm-related death. Assuming suitable AAA anatomy, these data justify a broad application of EVAR across a wide spectrum of patients. |
2 |
| 18. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010; 362(20):1863-1871. |
Experimental-Tx |
1,252 total patients |
Randomized trial to evaluate endovascular versus open repair or abdominal aortic aneurysm. |
The 30-day operative mortality was 1.8% in the endovascular-repair group and 4.3% in the open-repair group (adjusted odds ratio for endovascular repair as compared with open repair, 0.39; 95% confidence interval [CI], 0.18 to 0.87; P=0.02). The endovascular-repair group had an early benefit with respect to aneurysm-related mortality, but the benefit was lost by the end of the study, at least partially because of fatal endograft ruptures (adjusted hazard ratio, 0.92; 95% CI, 0.57 to 1.49; P=0.73). By the end of follow-up, there was no significant difference between the two groups in the rate of death from any cause (adjusted hazard ratio, 1.03; 95% CI, 0.86 to 1.23; P=0.72). The rates of graft-related complications and reinterventions were higher with endovascular repair, and new complications occurred up to 8 years after randomization, contributing to higher overall costs. In this large, randomized trial, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower operative mortality than open surgical repair. However, no differences were seen in total mortality or aneurysm-related mortality in the long term. Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly. |
1 |
| 20. Bastos Goncalves F, Baderkhan H, Verhagen HJ, et al. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. Br J Surg. 2014;101(7):802-810. |
Observational-Tx |
840 Patients |
To evaluate the role of early AAA sac dynamics in determining long-term outcome after EVAR. |
Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9 mm) in 142 (23.8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P < 0.001). Moderate compared with major shrinkage (HR 2.10; P = 0.022), early postoperative complications (HR 3.34; P < 0.001) and increasing abdominal aortic aneurysm baseline diameter (HR 1.02; P = 0.001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage. |
2 |
| 21. Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002; 35(5):1029-1035. |
Review/Other-Dx |
N/A |
International conference summary. |
The current endoleak classification system with some important modifications is adequate. Types I and II endoleak occur after 0% to 10% and 10% to 25% of EVAR, respectively. Many (30%-100%) type II endoleaks will seal and have no detrimental effect, which never or rarely occurs with type I endoleaks. Not all endoleaks can be visualized with any technique, and increased pressure (endotension) can be transmitted through clot. Aneurysm pulsatility after EVAR correlates poorly with endoleaks and endotension. An enlarging aneurysm after EVAR mandates surgical or interventional treatment. These and other conclusions will help to resolve controversy and aid in the management of these vexing complications and should also point the way to future research in this field. |
4 |
| 22. Picel AC, Kansal N. Essentials of endovascular abdominal aortic aneurysm repair imaging: preprocedural assessment. [Review]. AJR Am J Roentgenol. 203(4):W347-57, 2014 Oct. |
Review/Other-Dx |
N/A |
To understand the abdominal aortic aneurysm imaging characteristics that must be accurately described for endovascular aortic aneurysm repair treatment planning, including evaluation of the landing zones, aneurysm morphology, and vascular access. |
No Results in abstract. |
4 |
| 23. Picel AC, Kansal N. Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications. [Review]. AJR Am J Roentgenol. 203(4):W358-72, 2014 Oct. |
Review/Other-Dx |
N/A |
To review post-EVAR surveillance imaging modalities and complications that must be recognized and appropriately reported by the interpreting physician. |
No Results in abstract. |
4 |
| 24. Tse DM, Tapping CR, Patel R, et al. Surveillance after endovascular abdominal aortic aneurysm repair. [Review]. Cardiovasc Intervent Radiol. 37(4):875-88, 2014 Aug. |
Review/Other-Dx |
N/A |
To detect asymptomatic complications, so that early secondary intervention can prevent late aneurysm rupture. |
there is wide heterogeneity in surveillance strategies used among EVAR centres. |
4 |
| 25. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 32. Stavropoulos SW, Clark TW, Carpenter JP, et al. Use of CT angiography to classify endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2005; 16(5):663-667. |
Observational-Dx |
36 patients |
To determine the accuracy of CTA in the classification of endoleaks in patients who have undergone EVAR. |
There was agreement regarding endoleak classification between CTA and DSA on 86% of the patients (31/36 patients). Correlation between the CTA reading of the two readers was 94% (34/36 patients), yielding a kappa statistic of 0.8. Endoleak classification based on CTA correlates fairly well with DSA findings. However, optimal endoleak management requires performance of selective angiograms with DSA to classify endoleaks that are detected on CTA. |
1 |
| 37. Millen A, Canavati R, Harrison G, et al. Defining a role for contrast-enhanced ultrasound in endovascular aneurysm repair surveillance. J Vasc Surg. 58(1):18-23, 2013 Jul. |
Observational-Dx |
539 Patients |
To identify a role for CEUS within the EVAR surveillance program. |
During the study period, 539 patients underwent EVAR surveillance, of whom 33 (6%) had CEUS for unresolved issues (median age, 79; range, 66-90; 28 male). Median follow-up after EVAR was 23 months (range, 0-132). In all cases, CEUS was able to resolve the clinical issue, resulting in secondary intervention in 10 patients (30%). The remaining patients were returned to surveillance. Within the cohort of 33 patients, the clinical issues were categorized into three groups. Group 1: Endoleak of uncertain classification (n = 27: 21 type II, four type I, two had endoleak excluded). Group 2: Significant aneurysm expansion (>/= 5 mm) without apparent endoleak (n = 4: one type II, three had endoleak excluded). Group 3: Target vessel patency following fenestrated EVAR (n = 2: patency confirmed in both). |
3 |
| 38. Bredahl K, Taudorf M, Long A, et al. Three-dimensional ultrasound improves the accuracy of diameter measurement of the residual sac in EVAR patients. Eur J Vasc Endovasc Surg. 46(5):525-32, 2013 Nov. |
Observational-Dx |
124 Patients |
To determine the accuracy of 3D ultrasound and 2D ultrasound using 3D CTA as the gold standard, and, secondly, to determine the reproducibility of 3D ultrasound. |
Replacing 2D with 3D ultrasound, the mean difference was improved from 6.0 mm to 1.3 mm (p < .001), and the range of variability was reduced from 9.4 mm to 6.6 mm (p ¼ .009) using 3D CT as the gold standard. The mean difference between 3D ultrasound and 3D CT maximum diameter of the residual sac was 1.3 mm with upper and lower limits of agreement of 5.2 mm and 7.9 mm, respectively. Reproducibility measures of 3D ultrasound were 4 mm. |
3 |
| 39. AbuRahma AF, Welch CA, Mullins BB, Dyer B. Computed tomography versus color duplex ultrasound for surveillance of abdominal aortic stent-grafts. J Endovasc Ther. 2005; 12(5):568-573. |
Observational-Dx |
178 patients |
To compare the ability of CT and color duplex US to detect endoleak and accurately measure aortic aneurysm diameters after endovascular repair. |
Follow-up ranged from 1 to 53 months (mean 16), during which 367 paired CT and color duplex US studies were acquired. The mean diameter of the AAA sac after repair was 5.15 cm by CT vs 4.99 cm by color duplex US (P=0.07); 93% of paired studies were somewhat similar (=5 mm). Mean preoperative to postoperative AAA size changes throughout follow-up were: 0.60 mm for CT vs -0.58 mm for color duplex US (P=0.78). 34 (19%) endoleaks were detected (26 early and 8 late). Versus CT, the sensitivity, specificity, PPV, and NPV of color duplex US for detecting endoleaks were 68%, 99%, 85%, and 97%, respectively (kappa=0.73). Color duplex US was more accurate in detecting type I endoleak than type II (88% vs 50%, P=0.046). Although color duplex US has good correlation to CT in measuring the size of AAA, it has a lower sensitivity in detecting endoleak, particularly type II. Therefore, CT scans should remain the primary imaging modality for the diagnosis of endoleak. |
3 |
| 41. Abbas A, Hansrani V, Sedgwick N, Ghosh J, McCollum CN. 3D contrast enhanced ultrasound for detecting endoleak following endovascular aneurysm repair (EVAR). Eur J Vasc Endovasc Surg. 47(5):487-92, 2014 May. |
Observational-Dx |
23 Patients |
To assess the clinical utility and accuracy of 3D CEUS compared with standard 2D CEUS and CTA in post EVAR-surveillance, and its influence on patient management. |
30 paired 3D CEUS and CTA images were analysed from 23 patients. Endoleaks were detected in 17 images with CTA, 18 on 2D CEUS, and 18 on 3D CEUS. The sensitivity, specificity, positive, and negative predictive values of 3D CEUS to detect endoleak were 100%, 92%, 94%, and 100%, respectively. There was excellent correlation (r ¼ 0.935; p .0001) between CTA and 3D CEUS for AAA sac diameter. Only 3D CEUS detected the inflow and outflow arteries in all 18 scans with endoleak. 2D CEUS detected the inflow in 16 (88.8%) and CTA on 12 (66.6%) of the images. |
3 |
| 42. Iezzi R, Cotroneo AR. Endovascular repair of abdominal aortic aneurysms: CTA evaluation of contraindications. Abdom Imaging. 2006; 31(6):722-731. |
Review/Other-Dx |
N/A |
To review CTA anatomic contraindications for EVAR. |
Multidetector CTA represents the current standard of reference in the evaluation of the abdominal aorta and iliac axis anatomy because it provides all the details needed for selection of patients who are suitable for endograft and the choice of the appropriate device. |
4 |
| 43. Reginelli A, Capasso R, Ciccone V, et al. Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak. International Journal Of Surgery. 33 Suppl 1:S76-84, 2016 Sep. |
Review/Other-Dx |
54 adult patients with AAD or post-EVAR EL imaging findings |
To describe the usefulness of triphasic CTA in aortic assessment in both non-traumatic emergency and surveillance conditions. |
AAD was detected in 36 (67%) patients: 23 type A-AADs, and 13 type B-AADs. The presence of EL was observed in 18 (33%) patients: 1 type Ia, 5 types IIa, 2 types IIb, 1 type IIIa and 9 types IIIb. |
4 |
| 44. Saratzis A, Dattani N, Brown A, et al. Multi-Centre Study on Cardiovascular Risk Management on Patients Undergoing AAA Surveillance. European Journal of Vascular & Endovascular Surgery. 54(1):116-122, 2017 Jul. |
Review/Other-Tx |
1053 patients |
To assess cardiovascular risk reduction in patients with small AAA. |
In total, 1053 patients were included (mean age 74 ± 9 years, all men). Of these, 745 patients (70.8%) had been prescribed an antiplatelet agent and 787 (74.7%) a statin. Overall, only 666 patients (63.2%) were prescribed both a statin and antiplatelet. Two hundred and sixty eight patients (32.1%) were current smokers and the proportion of patients who continued to smoke decreased with age. Overall, only 401 patients (48.1%) were prescribed a statin, antiplatelet, and had stopped smoking. In the secondary analysis 38 AAA screening units (84% national coverage) replied. Thirty-one units (82%) suggest changes to the patient's prescription; however, none monitor compliance with these recommendations or assess whether the general practitioner has been made aware of the AAA diagnosis or prescription advice. |
4 |
| 45. Dillavou ED, Muluk SC, Makaroun MS. Improving aneurysm-related outcomes: nationwide benefits of endovascular repair. J Vasc Surg. 2006; 43(3):446-451; discussion 451-442. |
Review/Other-Tx |
N/A |
To evaluate a national Medicare database to establish the effect of EVAR introduction into the United States. |
Elective AAA repairs averaged 87.7 per 100,000 Medicare patients between 2000 and 2003, with EVAR has steadily increasing to 41% of elective repairs in 2003. From 2000 to 2003, overall elective AAA mortality declined from 5.0% to 3.7% (P<.001), while open repair mortality remained unchanged. Average elective repair hospital charges were not different between groups, but Medicare reimbursement was lower for EVAR, with a higher proportion cases classified as DRG 111. EVAR is replacing open surgery without an increase in overall case volume. EVAR is responsible for overall decrease in operative mortality even in ruptured aneurysms while decreasing utilization variables. Reimbursement to hospitals is shrinking, however. |
4 |
| 46. Dong H, Raterman B, White RD, et al. MR Elastography of Abdominal Aortic Aneurysms: Relationship to Aneurysm Events. Radiology. 304(3):721-729, 2022 09. |
Review/Other-Tx |
72 participants with AAA and 56 healthy participants |
To evaluate the use of aortic MR elastography (MRE)-derived AAA stiffness and stiffness ratio at baseline to identify the potential for future aneurysm rupture or need for surgical repair. |
Seventy-two participants with AAA (mean age, 71 years ± 9 [SD]; 56 men and 16 women) and 56 healthy participants (mean age, 42 years ± 16; 27 men and 29 women) were evaluated. In healthy participants, aortic stiffness positively correlated with age (? = 0.44; P < .001). AAA stiffness (event group [n = 21], 50.3 kPa ± 26.5 [SD]; no-event group [n = 21], 86.9 kPa ± 52.6; P = .01) and the stiffness ratio (event group, 0.7 ± 0.4; no-event group, 2.0 ± 1.4; P < .001) were lower in the event group than the no-event group at a mean follow-up of 449 days. AAA stiffness did not correlate with diameter in the event group (? = -0.06; P = .68) or the no-event group (? = -0.13; P = .32). AAA stiffness was inversely correlated with intraluminal thrombus area (? = -0.50; P = .01). |
4 |
| 47. Cayne NS, Veith FJ, Lipsitz EC, et al. Variability of maximal aortic aneurysm diameter measurements on CT scan: significance and methods to minimize. J Vasc Surg. 2004; 39(4):811-815. |
Observational-Dx |
23 AAA’s |
To evaluate the variability and methods to minimize substantial differences when measuring repeatedly the same AAA on the same CT scan. |
Routine CT maximal diameter measurement of AAAs can have substantial interobserver variability. Standardized measurement protocols can decrease, but not eliminate, this measurement variability. Thus apparent size changes based on CT measurements may represent measurement artifact rather than actual aneurysm growth or shrinkage, particularly when a standardized system is not used. |
3 |
| 48. Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009;50(4):880-896. |
Review/Other-Dx |
N/A |
To provide recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications. |
No results stated in abstract. |
4 |
| 49. Goshima S, Kanematsu M, Kondo H, et al. Preoperative planning for endovascular aortic repair of abdominal aortic aneurysms: feasibility of nonenhanced MR angiography versus contrast-enhanced CT angiography. Radiology. 267(3):948-55, 2013 Jun. |
Observational-Dx |
50 Patients |
To compare vascular measurements to determine stent types and configurations for abdominal endovascular aneurysm repair (EVAR) by comparing results of contrast material-enhanced computed tomographic (CT) angiography and nonenhanced magnetic resonance (MR) angiography. |
No significant difference was found in aortic neck diameter (observer 1: CT, 18.5 mm; MR, 19.0 mm; P = .43) (observer 2: CT, 19.6 mm; MR, 19.3 mm; P = .59), aortic neck diameter 15 mm distal to the lowest renal artery (observer 1: CT, 19.2 mm; MR, 19.2 mm; P = .38) (observer 2: CT, 19.6 mm; MR, 19.6 mm; P = .91), aortic neck length (observer 1: CT, 43.6 mm; MR, 43.6 mm; P = .85) (observer 2: CT, 44.4 mm; MR, 44.0 mm; P = .93), or other key vascular measurements (P = .23-.99) for preoperative planning. These included aneurysm diameter, lowest renal artery to aortic bifurcation length, aortic bifurcation diameter, common iliac artery diameters, external iliac artery diameters, length between orifices of lower renal and internal iliac arteries, and iliac artery sealing length. CT and MR angiography measurements showed very strong correlation (r = 0.92-0.99). Intraclass correlation coefficients between observers ranged from 0.90 to 0.98. Stent types and configurations determined with CT measurements remained unaltered when reassessed with MR measurements. |
1 |
| 50. Smith T, Quencer KB. Best Practice Guidelines: Imaging Surveillance After Endovascular Aneurysm Repair. [Review]. AJR. American Journal of Roentgenology. 214(5):1165-1174, 2020 05. |
Review/Other-Dx |
N/A |
To provide a comprehensive and evidence-based review regarding surveillance imaging after EVAR to help readers understand current societal guidelines, guide institutional protocols, and provide a framework to facilitate safe, cost-effective, and clinically relevant imaging of patients after EVAR. |
No results in abstract |
4 |
| 51. Ilyas S, Shaida N, Thakor AS, Winterbottom A, Cousins C. Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications. [Review]. Clin Radiol. 70(2):183-96, 2015 Feb. |
Review/Other-Dx |
N/A |
To educate on surveillance techniques after endovascular abdominal aortic aneurysm repair (EVAR) to prevent rupture or lower-limb ischaemia. |
No results reported. |
4 |
| 52. Geller SC. Imaging guidelines for abdominal aortic aneurysm repair with endovascular stent grafts. J Vasc Interv Radiol. 2003; 14(9 Pt 2):S263-264. |
Review/Other-Dx |
N/A |
Practice guidelines for AAA repair with endovascular stent grafts. |
N/A |
4 |
| 53. Timaran CH, Lipsitz EC, Veith FJ, et al. Endovascular aortic aneurysm repair with the Zenith endograft in patients with ectatic iliac arteries. Ann Vasc Surg. 2005; 19(2):161-166. |
Observational-Dx |
352 patients from Zenith study |
To determine whether large or ecstatic common iliac arteries are a risk factor for early and late endograft failure. |
Median follow-up was ~ 24 months. Freedom from iliac-related secondary intervention was not significantly different between the groups (KM, log-rank test, P=0.98) with rates at 1, 12, and 24 months of 98%, 97%, and 95% for patients with ecstatic common iliac arteries, and 100%, 95%, and 95% for patients with normal iliac arteries, respectively. The maximum common iliac arteries diameter was not a significant predictor of freedom from iliac-related secondary intervention (HR, 0.98; 95% CI, 0.7-1.4; p = 0.98). In patients with large common iliac arteries, indications for iliac-related secondary intervention included distal type I endoleak (1, 0.6%), type III endoleak (1, 0.6%), graft limb occlusion (4, 2.6%), and device stenosis (1, 0.6%). The Zenith endograft is effective for EVAR in patients with ecstatic common iliac arteries. Moreover, the presence of large common iliac arteries was not associated with an increased risk of adverse iliac-related outcome or subsequent iliac-related secondary intervention. Long-term surveillance, however, is mandatory, as iliac-related secondary interventions may be necessary. |
3 |
| 54. Schinkel AF, Kaspar M, Staub D. Contrast-enhanced ultrasound: clinical applications in patients with atherosclerosis. [Review]. The International Journal of Cardiovascular Imaging. 32(1):35-48, 2016 Jan. |
Review/Other-Dx |
N/A |
To explain the principles and ultrasound acquisition settings, and will focus on cardiac and vascular including carotid and aortic applications of CEUS |
No results in abstract |
4 |
| 55. Borgbjerg J, Christensen HS, Al-Mashhadi R, et al. Ultra-low-dose non-contrast CT and CT angiography can be used interchangeably for assessing maximal abdominal aortic diameter. Acta Radiol Open 2022;11:20584601221132461. |
Observational-Dx |
50 patients who underwent CTA and a normal-dose non-contrast CT for suspected renal artery stenosis |
To determine whether ultra-low-dose non-contrast CT (ULDNC-CT) can be used instead of the gold standard CT angiography (CTA) for assessment of maximal abdominal aortic diameter. |
Observers completed 1400 measurements encompassing repeated CTA and ULDNC-CT measurements. The mean diameter was 24.0 and 25.0 mm for CTA and ULDNC-CT, respectively, yielding a significant but minor mean difference of 1.0 mm. The 95% LOAM reproducibility was similar for CTA and ULDNC-CT (2.3 vs 2.3 mm). In addition, the 95% LOAM and mean diameters were similar for CTA and ULDNC-CT when observers were grouped as consultants and residents. |
2 |
| 56. Gallitto E, Faggioli G, Gargiulo M, et al. Planning, Execution, and Follow-up for Endovascular Aortic Aneurysm Repair Using a Highly Restrictive Iodinated Contrast Protocol in Patients with Severe Renal Disease. Annals of Vascular Surgery. 47:205-211, 2018 Feb. |
Observational-Tx |
18 patients |
To describe a mini-invasive approach aimed to minimize the exposure of these patients to iodinated contrast medium and the subsequent risk of renal function worsening. |
Eighteen patients (median age: 74 years, interquartile range [IQR]: 6, male: 78%, American Society of Anaesthesiologists [ASA] IV: 100%) were enrolled. The median AAA diameter and preoperative GFR were 66 mm (IQR: 13) and 22 mL/min (IQR: 4), respectively. Infrarenal (n = 10) and suprarenal fixation (n = 8) endografts were implanted, with a mean dose of iodinate contrast medium injection of 18 mL (IQR) and 100% TS rate. Two type II endoleaks were detected at the completion CEUS. The median postoperative GFR was 22 mL/min (IQR: 5). No patients had GFR worsening =30% at 1 day and 30 days. The 30-day mortality was 11% (2 deaths for heart failure). At a median follow-up of 16 months (IQR: 8), no patients needed hemodialytic treatment and no endoleaks were detected. One patient died at 6 months for cancer and one at 13 months for myocardial infarction. No reinterventions or AAA and renal-related mortality occurred during the follow-up. |
3 |
| 57. Lee R, Bellamkonda K, Jones A, et al. Flow Mediated Dilatation and Progression of Abdominal Aortic Aneurysms. European Journal of Vascular & Endovascular Surgery. 53(6):820-829, 2017 Jun. |
Review/Other-Tx |
62 patients with AAAs |
To investigate the role of Flow mediated dilatation (FMD) as a potential biomarker of AAA by assessments of FMD during the natural history in individuals with AAAs. |
FMD is inversely correlated with the diameter of AAAs in all patients (n=162, Spearman's r=-.28, p<.001). FMD is inversely correlated with AAA diameter progression in the future 12 months (Spearman's r=-.35, p=.001), particularly in the moderate size group. Furthermore, FMD deteriorates during the course of AAA surveillance (from a median of 2.0% at baseline to 1.2% at follow-up; p=.004), while surgical repair of AAAs (n=50 [open repair n=22, endovascular repair n=28)] leads to an improvement in FMD (from 1.1% pre-operatively to 3.8% post-operatively; p<.001), irrespective of the type of surgery. |
4 |
| 58. Borgbjerg J, Bogsted M, Lindholt JS, Behr-Rasmussen C, Horlyck A, Frokjaer JB. Superior Reproducibility of the Leading to Leading Edge and Inner to Inner Edge Methods in the Ultrasound Assessment of Maximum Abdominal Aortic Diameter. European Journal of Vascular & Endovascular Surgery. 55(2):206-213, 2018 Feb. |
Observational-Dx |
18 radiologists |
To determine reproducibility of caliper placement in relation to the aortic wall with the three principal methods: leading to leading edge (LTL), inner to inner edge (ITI), and outer to outer edge (OTO).To assess the mean difference between the OTO, ITI, and LTL diameters and estimate the impact of using either of these methods on abdominal aortic aneurysm (AAA) prevalence in a screening program. |
to determine reproducibility of caliper placement in relation to the aortic wall with the three principal methods: leading to leading edge (LTL), inner to inner edge (ITI), and outer to outer edge (OTO). The secondary aim was to assess the mean difference between the OTO, ITI, and LTL diameters and estimate the impact of using either of these methods on abdominal aortic aneurysm (AAA) prevalence in a screening program. |
3 |
| 59. Corriere MA, Islam A, Craven TE, Conlee TD, Hurie JB, Edwards MS. Influence of computed tomography angiography reconstruction software on anatomic measurements and endograft component selection for endovascular abdominal aortic aneurysm repair. Journal of Vascular Surgery. 59(5):1224-31.e1-3, 2014 May. |
Observational-Dx |
92 CTA Studies |
To evaluate influences of reconstruction software on anatomic measurements and endograft component selection for EVAR, and to directly compare length and diameter measurements obtained from 3D CTA reconstructions created from pre-EVAR axial CTA images of patients treated at a single institution using three different software programs. |
Diameter measurements were generally similar between programs. Mean diameters at all locations were within </= 1 mm of one another, and mean length measurements were within </= 10 mm of one another for all pairwise comparisons. Intraclass correlations coefficients between programs for diameter measurements were comparable between programs (>/= 0.82 for all diameter comparisons and >/= 0.88 for all length comparisons) and indicated good correlation. Pair-wise comparisons indicated similar rates of identical and adjacent size endograft component selection without an obvious trend toward superior agreement for any two programs. Rates of identical proximal endograft diameter selection ranged from 46% to 59%, whereas 89% to 100% of proximal endograft diameters selected between programs were within one adjacent (smaller or larger) size of each other. For iliac endograft selection, rates of identical component diameter selection between programs ranged from 36% to 69%, and 58% to 99% of selected iliac endograft diameters were within one adjacent size. |
3 |
| 60. Sobocinski J, Chenorhokian H, Maurel B, et al. The benefits of EVAR planning using a 3D workstation. Eur J Vasc Endovasc Surg. 2013;46(4):418-423. |
Observational-Dx |
295 Patients |
To evaluate the influence of planning endovascular aneurysm repair (EVAR) with a three-dimensional (3D) workstation on early and midterm outcomes. Contrast was administered during this study. |
A total of 295 patients (149 patients in group 1 and 146 patients in group 2) were included. All patients had completed a minimum of 2 years of follow-up. During this 2-year period following EVAR, the type 1 endoleak rate was 8.7% in group 1 and 1.4% in group 2 (p ¼ .004) respectively. Secondary intervention rates related to type 1 endoleak was 5.4% in group 1 and 0 in group 2 (p < .001). No difference was observed regarding all-cause mortality, aneurysm-related death, and freedom from secondary intervention rates during follow-up. |
3 |
| 61. Tatli S, Lipton MJ, Davison BD, Skorstad RB, Yucel EK. From the RSNA refresher courses: MR imaging of aortic and peripheral vascular disease. Radiographics. 2003; 23 Spec No:S59-78. |
Review/Other-Dx |
N/A |
To review various methods and protocols for studying the aorta and lower limb vasculature. |
Understanding the principles of the main MRA techniques is essential for consistent acquisition of diagnostic images. In addition, tailoring the acquisition parameters and the imaging protocol to the vessel being imaged and the clinical question is mandatory for optimal results. Future technical developments that will lead to faster image acquisition and better contrast agents promise to further improve image quality. |
4 |
| 62. Ludman CN, Yusuf SW, Whitaker SC, Gregson RH, Walker S, Hopkinson BR. Feasibility of using dynamic contrast-enhanced magnetic resonance angiography as the sole imaging modality prior to endovascular repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 19(5):524-30, 2000 May. |
Observational-Dx |
16 patients |
To establish the feasibility of using MRI with dynamic contrast-enhanced MRA as the sole imaging modality in the assessment of patients prior to endovascular repair of AAAs. |
High-quality MRA/MRI and CT images were obtained in 16 patients. Six patients were considered suitable for an endovascular approach, one was considered borderline and 9 patients were judged unsuitable. In all cases, the overall management determined by the two methods concurred. Comparison of the two imaging modalities resulted in agreement as to suitability for an endovascular approach. We therefore conclude that in our group the use of MRI and dynamic contrast-enhanced MRA proved effective as a sole imaging modality for the assessment of these patients. |
3 |
| 63. Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries. Arch Intern Med. 2012;172(19):1456-1462. |
Review/Other-Dx |
781, 264 patients |
To examine the association between the SAAAVE Act and abdominal ultrasonography for AAA screening, elective AAA repair, hospitalization for AAA rupture, and all-cause mortality among male beneficiaries newly enrolled in Medicare. |
Fewer than 3% of abdominal ultrasonography claims after 2007 were for SAAAVE-specific AAA screening. There was a significantly greater increase in abdominal ultrasonography use among SAAAVE-eligible beneficiaries (2.0 percentage points among 65-year-old men, from 7.6% in 2004 to 9.6% in 2008; 0.7 points [8.9% to 9.6%] among 70-year-old men; 0.7 points [10.8% to 11.5%] among 76-year-old men; and 0.9 points [7.5% to 8.4%] among 65-year-old women) (P < .001 for all comparisons with 65-year-old men). The SAAAVE Act was associated with increased use of abdominal ultrasonography in 65-year-old men compared with 70-year-old men (adjusted odds ratio [AOR], 1.15; 95% CI, 1.11-1.19) (P < .001), and this increased use remained even when SAAAVE-specific AAA screening was excluded (AOR, 1.12; 95% CI, 1.08-1.16) (P < .001). Implementation of the SAAAVE Act was not associated with changes in rates of AAA repair, AAA rupture, or all-cause mortality. |
4 |
| 64. Thurnher S, Cejna M. Imaging of aortic stent-grafts and endoleaks. Radiol Clin North Am. 2002;40(4):799-833. |
Review/Other-Dx |
N/A |
To provide a review of imaging of aortic stent-grafts and endoleaks. |
No results stated in abstract. |
4 |
| 65. Garg T, Baker LC, Mell MW. Adherence to postoperative surveillance guidelines after endovascular aortic aneurysm repair among Medicare beneficiaries. Journal of Vascular Surgery. 61(1):23-7, 2015 Jan.J Vasc Surg. 61(1):23-7, 2015 Jan. |
Review/Other-Dx |
9695 Patients |
To describe long-term adherence to surveillance guidelines among United States Medicare beneficiaries and determine patient and hospital factors associated with incomplete surveillance. |
Our cohort comprised 9695 patients. Median follow-up duration was 6.1 years. A CT scan #30 days of EVAR was performed in 3085 (31.8%) patients and #60 days in 60.8%. The median time to the postoperative CT was 38 days (interquartile range, 25-98 days). Complete surveillance was observed in 4169 patients (43.0%). For this group, the mean follow-up time was shorter than for those with incomplete surveillance (3.4 6 2.74 vs 6.5 6 2.1 years; P < .001). Among those with incomplete surveillance, follow-up became incomplete at 3.3 6 1.9 years, with 57.6% lost to follow-up, 64.1% with gaps in follow-up (mean gap length, 760 6 325 days), and 37.6% with both. A multivariable analysis showed incomplete surveillance was independently associated with Medicaid eligibility (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.29-1.55; P < .001), low-volume hospitals (HR, 1.12; 95% CI, 1.05-1.20; P < .001), and ruptured abdominal aortic aneurysm (HR, 1.51; 95% CI, 1.24-1.84; P < .001). |
4 |
| 66. Gill HL, Ladowski S, Sudarshan M, et al. Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair. J Vasc Surg. 60(2):325-9, 2014 Aug. |
Observational-Dx |
134 Patients |
To determine if a negative result of first postoperative imaging by computed tomography (CT) scan was predictive of decreased need for reintervention. We hypothesized that initial negative postoperative imaging could identify a low-risk cohort of patients who could be observed less frequently. |
A total of 134 patients were included in the analysis. A total of 107 patients (80%) had negative initial postoperative imaging, whereas 27 patients (20%) had evidence of an endoleak. There were no significant differences between the two groups in terms of comorbidities or anticoagulation status. Kaplan-Meier survival curves showed that there was a significant difference between those patients who had a negative initial CT scan and those who had a positive scan for endoleak in terms of both overall reintervention rates and leak-related reintervention rates. Endoleak on the first postoperative CT scan was associated with a hazard ratio of 6.37 (confidence interval, 2.02-20.10; P = .002) for leak-related reintervention and a hazard ratio of 6.01 (confidence interval, 2.24-16.17; P < .001) for all-cause reintervention. |
3 |
| 67. Patel MS, Carpenter JP. The value of the initial post-EVAR computed tomography angiography scan in predicting future secondary procedures using the Powerlink stent graft. J Vasc Surg. 2010; 52(5):1135-1139. |
Observational-Dx |
345 patients 1,519 post-EVAR CT scans |
To determine if surveillance CT angiography (CTA) can be safely reduced after endovascular abdominal aortic aneurysm repair (EVAR) |
Of the 58 core laboratory identified findings, the inciting abnormality was present on the initial postoperative scan in 49 (84%). Of the remaining nine CT-driven procedures, three (5.2%) were due to late sac expansion attributed to type II endoleak (n=2) or endotension (n=1); two (3.4%) were for prophylactic reasons in the absence of endoleak; and four (6.8%) were in patients with type II endoleak not observed by the core laboratory and without sac expansion. The negative predictive value of the initial postoperative CTA for the need for a secondary procedure is therefore 96.4%, which can be improved to 97.6% with duplex ultrasound surveillance to detect sac expansion. Thus, a negative initial postoperative CTA is highly predictive of long-term freedom from secondary intervention. Among enrolled patients with suitable anatomy for EVAR, most abnormalities that result in a secondary procedure are detected on the initial postoperative CTA or present with clinical symptoms. Long-term surveillance CTA may therefore be replaced by duplex ultrasound imaging if the initial postoperative CTA shows no abnormalities. |
3 |
| 68. Sternbergh WC, 3rd, Greenberg RK, Chuter TA, Tonnessen BH. Redefining postoperative surveillance after endovascular aneurysm repair: recommendations based on 5-year follow-up in the US Zenith multicenter trial. J Vasc Surg. 2008; 48(2):278-284; discussion 284-275. |
Observational-Tx |
739 patients |
To examine the correlation of early endoleaks with the long-term outcome in patients treated in the Zenith (Cook Inc, Bloomington, Ind) United States (US) multicenter trial, assessing possible correlation with early endoleak. |
EVAR was done in 739 patients (mean follow-up, 29.9 +/- 17.1 months). Freedom from endoleak at 1 month was highly predictive (P < .001) of reduced ARM: freedom from ARM was 92.3%, 89.8%, 85.2%, 83.1% and 83.1 % at 1, 2, 3, 4, and 5 years, respectively, in patients without endoleak (83.1%) and 75%, 67.1%, 61.5%, 55.9%, and 55.9% in patients with endoleak (16.9%). Cumulative absence of endoleak at 1 year (77.6%) was associated with 94%, 91.5%, 88.1%, 85.8%, and 85.8% 1- to 5-year freedom from ARM vs 73.3%, 66.7%, 56.6%, 52.5%, and 52.5% in patients with endoleak </=1 year (22.4%), P < .001. In patients without endoleak at 12 months, the subsequent risk of any ARM was 8.2% (5-year risk, 14.2%; 1-year risk, 6.0%). In patients with significant sac shrinkage (>/=5 mm) and cumulative absence of endoleak at 12 months, the subsequent risk of an ARM was 5.3% (5-year risk, 11.1%; 1-year risk, 5.8%). |
2 |
| 69. Farner MC, Carpenter JP, Baum RA, Fairman RM. Early changes in abdominal aortic aneurysm diameter after endovascular repair. J Vasc Interv Radiol. 14(2 Pt 1):205-10, 2003 Feb. |
Observational-Dx |
63 patients |
To determine the rate of diameter change in AAA treated by endovascular repair. |
The mean and median follow-up interval was 12 months. There was a significant decrease in maximum diameter at follow-up (6.0 cm vs 5.1 cm; P<.001). The mean annual decrease of AAA diameter was 8.4 mm. There is a significant difference in mean annual diameter change between patients with treated endoleak and those with persistent endoleak (P<.05). There was no difference in mean annual rate of change between patients with no endoleak and those with treated endoleak (8.4 mm/y vs 11 mm/y; P=NS). Patients with resolved endoleak exhibit a similar shrinkage rate to patients who never had endoleak during imaging follow-up. There remains a group of patients without significant sac shrinkage after EVAR yet have no endoleak on follow-up imaging (ie, endotension). It is still unclear whether these patients have received protection from AAA rupture from EVAR. |
3 |
| 70. Bargellini I, Cioni R, Petruzzi P, et al. Endovascular repair of abdominal aortic aneurysms: analysis of aneurysm volumetric changes at mid-term follow-up. Cardiovasc Intervent Radiol. 2005; 28(4):426-433. |
Observational-Dx |
63 consecutive patients |
To evaluate the volumetric changes in AAA after EVAR in 24 months of follow-up. |
Mean volume reduction rates were 6.5%, 8%, and 9.6% at 6, 12, and 24 months follow-up, respectively. Mean Dmax reduction rates were 4.2%, 6.7%, and 12%; correlation with volumes was poor (r=0.73-0.81). The accuracies of volume changes in predicting endoleaks ranged between 74.6% and 84.1% and were higher than those of Dmax modifications. The strongest independent predictor of endoleak was a volume change at 6 months =0.3% (P=0.005), although 6/19 (32%) patients with endoleak showed no significant AAA enlargement, whereas in 6 of 44 (14%) patients without endoleak the aneurysm enlarged. The lack of volume decrease in the aneurysm of at least 0.3% at 6 months follow-up indicates the need for closer surveillance, and has a higher predictive accuracy for an endoleak than Dmax. |
3 |
| 71. Demehri S, Signorelli J, Kumamaru KK, et al. Volumetric quantification of type II endoleaks: an indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair.[Erratum appears in Radiology. 2015 Oct;277(1):308 Note: Steinger, Michael L [corrected to Steigner, Michael L]; PMID: 26402504]. Radiology. 271(1):282-90, 2014 Apr. |
Observational-Dx |
72 Patients |
To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta. Intravenous contrast was administered. |
In 56 (49.5%) of 113 CT studies in type II endoleaks, there was an interval increase in ASV. The accuracies of ECVDEP (area under the ROC curve [AUC], 0.85) and normalized ECVDEP (AUC, 0.86) were superior to the accuracies of ECDM (AUC, 0.73), ECDT (AUC, 0.73), and ECVAEP (AUC, 0.66). At ROC curve analysis, the sensitivity, specificity, and positive and negative predictive values for type II endoleak cavities with an ECVDEP of less than 0.5 mL for showing no future sac volume enlargement were 33% (19 of 57), 100% (56 of 56), 100% (19 of 19), and 60% (56 of 94), respectively. |
2 |
| 72. Prinssen M, Verhoeven EL, Verhagen HJ, Blankensteijn JD. Decision-making in follow-up after endovascular aneurysm repair based on diameter and volume measurements: a blinded comparison. Eur J Vasc Endovasc Surg. 2003; 26(2):184-187. |
Observational-Dx |
82 patients |
To assess whether volume, in addition to diameter, measurements facilitate decision-making after EVAR. |
The intra-observer agreement was 0.93 for both diameter and volume. Volume data resulted in significantly more “good/wait” decisions out to 36 months. Diameter data resulted in more “not good/Dx or Rx”– decisions out to 36 months (all P<50.005). Post-EVAR aneurysm sac volume data appears to provide earlier reassurance, reduce unnecessary interventions and to be more sensitive to secondary problems than diameter data alone. |
1 |
| 73. Pitton MB, Schweitzer H, Herber S, et al. MRI versus helical CT for endoleak detection after endovascular aneurysm repair. AJR. 2005; 185(5):1275-1281. |
Observational-Dx |
52 patients |
To investigate the diagnostic accuracy of MRI and helical CT for endoleak detection. |
The incidence of types I, II, and III endoleaks and complex endoleaks was 3.2%, 40.1%, 8.7%, and 4.0%, respectively. The sensitivity for endoleak detection was 92.9%, 44.0%, 34.8%, and 38.3% for MRI, biphasic CT, uniphasic arterial CT, and uniphasic late CT, respectively. The corresponding NPV were 91.7%, 58.4%, 54.7%, and 56.1%, respectively. The overall accuracy of endoleak detection and correct sizing was 95.2%, 58.3%, 55.6%, and 57.1% for MRI, biphasic CT, uniphasic arterial CT, and uniphasic late CT, respectively. MRI is significantly superior to biphasic CT for endoleak detection and rating of endoleak size, followed by uniphasic late and uniphasic arterial CT scans. MRI shows a significant number of endoleaks in cases with negative CT findings and may help illuminate the phenomenon of endotension. Endoleak rates reported after EVAR substantially depend on the imaging techniques used. |
3 |
| 74. AbuRahma AF. Fate of endoleaks detected by CT angiography and missed by color duplex ultrasound in endovascular grafts for abdominal aortic aneurysms. J Endovasc Ther. 2006; 13(4):490-495. |
Observational-Dx |
232 patients |
To analyze the clinical implications of endoleaks documented by CTA and missed by color duplex US. |
39 endoleaks were documented in 35 (15%) of 232 patients using CTA. The mean follow-up was 25 months (range 1-64). Color duplex US was more helpful in detecting type I endoleaks than type II endoleaks (89% vs 58%, P<0.05). 19 (49%) type II endoleaks (16 early, 3 late) were diagnosed using CTA, 11 (58%) of which were detected by color duplex US (6 early and 2 late missed). Overall, color duplex US failed to identify endoleak in 11 (28%) of 39 endoleaks [2 late type I, 8 type II (6 early, 2 late), and 1 early type IV]. Consequences to treatment occurred in 2 (20%): one type I endoleak required treatment and one type II endoleak would have missed treatment. Color duplex US has a lower sensitivity in detecting endoleak, particularly type II; therefore, EVAR surveillance should not be based solely on color duplex US. Although a significant number of type II endoleaks resolved spontaneously, intervention can be offered for type II endoleaks if associated with an increasing sac size. |
3 |
| 75. Berczeli M, Chinnadurai P, Chang SM, Lumsden AB. Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging. Journal of Visualized Experiments. (178), 2021 12 09. |
Review/Other-Dx |
Patient I: 82-year-old male patient; Patient II: 62-year-old male patient |
To describe the technical and practical aspects of dynamic CTA imaging for endoleak characterization and introduces a 2D-3D image fusion approach with d-CTA for intra-operative image guidance. |
No results in abstract. |
4 |
| 76. Merkle EM, Klein S, Kramer SC, Wisianowsky C. MR angiographic findings in patients with aortic endoprostheses. AJR. 2002; 178(3):641-648. |
Review/Other-Dx |
N/A |
A pictorial essay of MRA findings in various patients with aortic endoprostheses. |
Currently, multislice CT represents the imaging gold standard after endovascular repair of aortic aneurysms. MRA may become an alternative imaging modality because the development of improved hardware and software and the bolus-triggered application of contrast medium now permit satisfactory visualization of both the arterial and venous vascular systems. An important advantage of MRI relates to the low toxicity of its contrast agents; hence, MRA can be used instead of CT, particularly in patients with renal insufficiency. Finally, the amount of radiation exposure associated with an imaging modality must be considered, particularly in young patients, when selecting an imaging modality for a patient who has undergone endovascular repair of traumatic aortic rupture. |
4 |
| 77. Klemm T, Duda S, Machann J, et al. MR imaging in the presence of vascular stents: A systematic assessment of artifacts for various stent orientations, sequence types, and field strengths. J Magn Reson Imaging. 2000; 12(4):606-615. |
Review/Other-Dx |
8 different stent types |
A systematic evaluation of the potential quality of MRI recorded in the presence of metallic stents. |
The optimal strategy for visualization of vascular and perivascular regions outside the stents was fast spin-echo imaging with the stent axis and read direction parallel to the static field. Susceptibility-induced signal void in gradient-echo images was minimal using the three-dimensional approach. Increased transmitter amplitudes above usual values provided clearly improved insight in the lumen using gradient-echo sequences. |
4 |
| 78. Ayuso JR, de Caralt TM, Pages M, et al. MRA is useful as a follow-up technique after endovascular repair of aortic aneurysms with nitinol endoprostheses. J Magn Reson Imaging. 2004; 20(5):803-810. |
Observational-Dx |
28 patients |
To evaluate whether MRA is a useful tool for the follow-up of aortic aneurysms treated with nitinol endoluminal grafts. |
Three type III leaks were correctly assessed at both examinations; however, CTA was less sensitive (50%) than MRA in depicting type II or unclassified leaks. No differences in aneurismal size were observed between the two examinations or between arterial signal-to-noise ratios observed in or out of the devices. MRA can provide all relevant information necessary for the follow-up of patients treated with nitinol endoprostheses, and performs better than CTA in detecting endoleaks. |
3 |
| 79. Habets J, Zandvoort HJ, Reitsma JB, et al. Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. [Review]. Eur J Vasc Endovasc Surg. 45(4):340-50, 2013 Apr. |
Review/Other-Dx |
11 Articles; 369 Patients |
The purpose of this systematic review was to examine whether magnetic resonance imaging (MRI) or computed tomography angiography (CTA) is more sensitive for the detection of endoleaks in patients with abdominal aortic aneurysm (AAA) after EVAR. |
Eleven articles were included. The overall methodological quality of the articles was good. In total, 369 patients with 562 MRI and 562 CTA examinations were included. A total of 146 endoleaks were detected by CTA; MRI detected all but two of these endoleaks. With MRI 132 additional endoleaks were found. |
4 |
| 80. Kawada H, Goshima S, Sakurai K, et al. Utility of Noncontrast Magnetic Resonance Angiography for Aneurysm Follow-Up and Detection of Endoleaks after Endovascular Aortic Repair. Korean Journal of Radiology. 22(4):513-524, 2021 04. |
Observational-Dx |
46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both CTA and b-TFE MRA after EVA |
To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). |
There were robust intermodality (r = 0.92-0.99) correlations and interobserver (intraclass correlation coefficient = 0.97-0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, "mottled high-intensity" and "creeping high-intensity with the low-band rim" were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas "no signal black spot" and "layered high-intensity area" were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40-0.88) displayed moderate-to-almost perfect agreement. |
2 |
| 81. Ersoy H, Jacobs P, Kent CK, Prince MR. Blood pool MR angiography of aortic stent-graft endoleak. AJR Am J Roentgenol. 182(5):1181-6, 2004 May. |
Observational-Dx |
7 patients |
To investigate the value of a blood pool contrast agent in detecting endoleaks on MR angiography after endoluminal stent-graft repair of infrarenal aortic aneurysms. |
No results stated in abstract. |
2 |
| 82. Ichihashi S, Marugami N, Tanaka T, et al. Preliminary experience with superparamagnetic iron oxide-enhanced dynamic magnetic resonance imaging and comparison with contrast-enhanced computed tomography in endoleak detection after endovascular aneurysm repair. J Vasc Surg. 58(1):66-72, 2013 Jul. |
Observational-Dx |
23 patients |
To examine superparamagnetic iron oxide (SPIO)-enhanced dynamic MRI as a potential alternative to contrast-enhanced computed tomogrpahy (CE-CT) for detection of endoleaks after EVAR. |
A total of 11 type II endoleaks originating from either the lumbar or inferior mesenteric artery were detected. Eight were able to be detected by CE-CT (8/11:73%) and 10 (10/11:91%) by SPIO-enhanced MRI. Interobserver (kappa = 0.91; 95% CI, 0.74-1.00) and intraobserver agreement for MRI (kappa = 1.00) were excellent. Intermodality agreement for endoleak detection was moderate (kappa = 0.63; 95% CI, 0.32-0.94; and kappa = 0.62; 95% CI, 0.29-0.95 for observers A and B, respectively). |
1 |
| 83. Resta EC, Secchi F, Giardino A, et al. Non-contrast MR imaging for detecting endoleak after abdominal endovascular aortic repair. Int J Cardiovasc Imaging. 29(1):229-35, 2013 Jan. |
Observational-Dx |
23 Patients |
To investigate the possibility of ruling out endoleak after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) using non-contrast MRI. |
Out of 23 patients, 13 (57%) were negative for endoleak at final assessment, while the remaining 10 (43%) were positive, with the following type distribution: Ia (n = 4), Ib (n = 2), II (n = 3), and III (n = 1). Sensitivity was 10/10 (100%; CI 95% 69-100%), specificity 7/13 (54%; 25-81%), accuracy 17/23 (74%; 52-90%), PPV 10/16 (63%; 35-85%) and NPV 7/7 (100%; 59-100%) for R1; 9/10 (90%; 56-100%), 8/13 (62%; 32-86%), 17/23 (74%; 52-90%), 9/14 (64%; 35-8%), and 8/9 (89%; 52-100%) for R2, respectively. Inter-reader Cohen kappa was 0.810. |
3 |
| 84. Parent FN, Meier GH, Godziachvili V, et al. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg. 2002; 35(3):474-481. |
Observational-Dx |
83 patients |
To demonstrate the value of color duplex US scanning in the detection of type I endoleak and type II endoleak, and determine the correlation of Doppler scan waveform pattern to endoleak persistence or seal, and describe the natural history of endoleak. |
Color duplex US scan is effective in the identification of the type of endoleak, the delineation of the vessel involved, and the hemodynamic information not available with any other testing method. Endoleaks have a dynamic natural history characterized by a variable onset with changing branch vessel involvement and spectral flow patterns. Periodic long-term endograft surveillance with color duplex US scanning is necessary for following existing endoleaks and for detecting new ones. Corroboration of these findings in larger multicenter prospective trials will be needed to determine whether color duplex US scan analysis of endoleaks would be predictive of long-term success in endovascular AAA repair. |
4 |
| 85. Collins JT, Boros MJ, Combs K. Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography. Ann Vasc Surg. 2007; 21(6):671-675. |
Observational-Dx |
160 patients |
To evaluate US surveillance as being adequate and safe for monitoring EVAR. |
CT discovered three endoleaks that were not seen with US. However, these particular US exams were inadequate due to additional factors (bowel gas, body habitus, hernia), which prompted CT investigation and, hence, endoleak discovery. Of the 41 endoleaks found on US, only 14 were seen on CT. Specifically, 26 type II endoleaks were seen with US vs only nine during CT. Additional factors addressed included comparison between US and CT of residual aneurysm sac measurements and conditions limiting US examination. Although criticized in the past, color flow US is a safe and effective modality for surveillance of aortic endografts. Utilizing US to analyze AAA sac dimensions and endoleak detection is statistically sound for screening AAA status post-EVAR. |
3 |
| 86. Manning BJ, O'Neill SM, Haider SN, Colgan MP, Madhavan P, Moore DJ. Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography. J Vasc Surg. 2009; 49(1):60-65. |
Observational-Dx |
132 EVAR patients, 117 attended follow-up |
To compare CTA as the gold standard with duplex US during EVAR follow-up to determine whether duplex US may be used as an alternative. |
There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. PPV for duplex US was 45% and NPV 94%. Specificity of duplex US for endoleak detection was 67% when compared with CTA, because of the large number of false positive duplex US results. Sensitivity for duplex US was 86%, with all clinically significant endoleaks demonstrated on CTA also detected on duplex US. Despite its low PPV, we found duplex US to be a sensitive test for the detection of clinically significant endoleaks. Given concerns about cumulative radiation exposure and cost, and the surprisingly low sensitivity of CTA for endoleak detection in this series, selective CTA based on duplex US surveillance may be a more appropriate long-term strategy. |
2 |
| 87. Gray C, Goodman P, Herron CC, et al. Use of colour duplex ultrasound as a first line surveillance tool following EVAR is associated with a reduction in cost without compromising accuracy. Eur J Vasc Endovasc Surg. 44(2):145-50, 2012 Aug. |
Observational-Dx |
145 Patients |
To evaluate the potential cost savings obtained by using CDUS rather than CT as the first line imaging method for post-EVAR surveillance and compare the efficacy of the two modalities to ensure that any cost saving would not compromise accuracy of follow up. |
Adopting a protocol where CDUS was employed as the first line surveillance tool following EVAR would result in a reduction in the number of postoperative CTs required in 2010 from 235 to 36. Based on 2010 costings, this would equate to an estimated reduction in expenditure from euro117,500 to euro34,915 a saving of euro82,585. CDUS had a sensitivity of 100% and a specificity of 85% in the detection of endoleaks compared to CT. The positive predictive value was 28% and negative predictive value 100%. The Pearson Coefficient correlation of 0.96 indicates a large degree of correlation between CDUS and CT when measuring residual aneurysm size following EVAR. |
3 |
| 88. Perini P, Sediri I, Midulla M, Delsart P, Gautier C, Haulon S. Contrast-enhanced ultrasound vs. CT angiography in fenestrated EVAR surveillance: a single-center comparison. J Endovasc Ther. 19(5):648-55, 2012 Oct. |
Observational-Dx |
62 Patients |
To evaluate contrast-enhanced ultrasound (CEUS) as an effective alternative to computed tomographic angiography (CTA) during follow-up after fenestrated endovascular aneurysm repair (EVAR) of juxtarenal aortic aneurysms. |
The mean diameters of the aneurysm sac were 56.58+/-8.56 mm with CEUS and 57.70+/-8.59 mm with CTA. The mean difference in aneurysm sac diameter was -1.13+/-3.19 mm (95% CI -0.34 to -1.92), with CTA measurements tending to be slightly larger. Bland-Altman plots showed good agreement between the imaging modalities with respect to aneurysm sac diameter (Spearman correlation coefficient r(s)=0.921, p<0.01). Endoleaks were detected by CTA in 7 (11.3%) of 62 patients and by CEUS in 6 (9.7%). In 59 (95.16%) cases, the tests agreed, and their equivalence was confirmed by binomial distribution testing. There was complete agreement between CEUS and CTA in the assessment of target vessels (144/146 patent target arteries; 1 had a significant stenosis and another was thrombosed). |
2 |
| 89. Gurtler VM, Sommer WH, Meimarakis G, et al. A comparison between contrast-enhanced ultrasound imaging and multislice computed tomography in detecting and classifying endoleaks in the follow-up after endovascular aneurysm repair. J Vasc Surg. 58(2):340-5, 2013 Aug. |
Observational-Dx |
171 Patients |
To compare contrast-enhanced ultrasound (CEUS) imaging and multislice computed tomography (MS-CT) angiography in detecting and classifying endoleaks in the follow-up of patients after endovascular aneurysm repair (EVAR). |
From the 132 patients in our cohort, we obtained 200 contemporary imaging examination pairs. MS-CT was used as the preferred examination in determining the presence of an endoleak. The true-positive rate for the detection of endoleaks with CEUS imaging was 42% (84 of 200), the false-positive rate was 4% (8 of 200), the true-negative rate was 52% (105 of 200), and the false-negative rate was 2% (3 of 200). The sensitivity of CEUS imaging was therefore 97%, and the specificity was 93%. The McNemar test value was 0.227, and the k coefficient was 0.889. |
3 |
| 90. Gargiulo M, Gallitto E, Serra C, et al. Could four-dimensional contrast-enhanced ultrasound replace computed tomography angiography during follow up of fenestrated endografts? Results of a preliminary experience. Eur J Vasc Endovasc Surg. 48(5):536-42, 2014 Nov. |
Observational-Dx |
22 Patients |
To evaluate four-dimensional contrast-enhanced ultrasound (4D-CEUS) as an alternative imaging method to computed tomography angiography (CTA) during follow up of fenestrated endovascular aneurysm repair (FEVAR) for juxta- and para-renal abdominal aortic aneurysms (AAA). |
Twenty-two patients (96% male, 4% female; mean age 74 +/- 7 years; American Society of Anesthesiologists grade III/IV 82%/18%) were enrolled. Seventy-eight RVV (fenestrations: 60; scallops: 17; branches: 1) were analyzed. The mean AAA diameter evaluated by 4D-CEUS and CTA was 45 +/- 10 mm (range 30-69 mm) and 48 +/- 9 mm (range 32-70 mm), respectively. The mean difference was 3 +/- 3 mm. The mean AAA volume evaluated by 4D-CEUS and CTA was 150 +/- 7 cc (range 88-300 cc) and 159 +/- 68 cc (range 80-310 cc), respectively. The mean difference was 7 +/- 4 cc; a Bland-Altman plot revealed agreement in AAA diameter and volume evaluation (p < .01) between 4D-CEUS and CTA. The observed agreement for the detection of endoleaks was 95%. McNemar's Chi-square test confirmed that 4D-CEUS and CTA were equivalent (p > .05) at detecting endoleaks. The first segment of six (8%) RVVs (four renal and two superior mesenteric arteries) was not directly visualized by 4D-CEUS owing to obesity, but the contrast enhancement into the distal part of vessel or into the relative parenchyma gave indirect information about their patency. McNemar's Chi-square test demonstrated the superiority of CTA (p = .031) in visualizing RVVs. The patency of 77/78 RVVs was confirmed with both techniques. McNemar's Chi-square test confirmed that 4D-CEUS and CTA were equivalent in their ability to detect visceral vessel patency. |
2 |
| 91. Schaeffer JS, Shakhnovich I, Sieck KN, Kallies KJ, Davis CA, Cogbill TH. Duplex Ultrasound Surveillance After Uncomplicated Endovascular Abdominal Aortic Aneurysm Repair. Vascular & Endovascular Surgery. 51(5):295-300, 2017 Jul. |
Observational-Dx |
266 patients that underwent EVAR |
To review our experience using Duplex ultrasound scan (DUS) as an initial and subsequent surveillance technique after uncomplicated EVAR. |
Mean follow-up was 3.2 years for 266 patients. Fifty-seven endoleaks (7 type I, 50 type II) were detected in 51 patients (19%). Nineteen (33%) endoleaks were identified and monitored by DUS alone. Nine (16%) endoleaks were identified on CTA without prior DUS. Twenty-two (39%) endoleaks were identified on DUS and confirmed by CTA; 6 of these patients had a secondary intervention. When compared to subsequent CTA, there were 7 discordant results: 4 false-negative and 3 false-positive endoleaks on DUS. Two of these patients with discordant results required intervention. Follow-up CTA was not obtained for the other 2 patients due to severe comorbidities including renal disease. One of these patients eventually developed abdominal aortic aneurysm rupture and death. Among 88 patients with both DUS and CTA, positive predictive value and negative predictive value for DUS were 0.88 and 0.94, respectively. Sac size on DUS compared to CTA resulted in an interclass correlation coefficient of r = .84. |
2 |
| 92. Chisci E, Harris L, Guidotti A, et al. Endovascular Aortic Repair Follow up Protocol Based on Contrast Enhanced Ultrasound Is Safe and Effective. European Journal of Vascular & Endovascular Surgery. 56(1):40-47, 2018 07. |
Observational-Dx |
880 patients |
To define the safety and effectiveness of a contrast enhanced ultrasound (CEUS) based follow up for endovascular aortic repair (EVAR) surveillance at a mid-term period (4 years). |
A total of 880 patients (mean age 75.6 ± 8.4 years; 824 male) who underwent EVAR between 1999 and 2015 and with a minimum of 1 year follow up were included. Six hundred and nineteen patients were in Group A (70%) and the remaining 261 in Group B (30%). Median follow up was 48 months (interquartile range 24-84). During the study period 318 CEUS scans were performed with no related complications. Indications for CEUS were the following: (a) 160 (50%) endoleak presence, (b) 34 (11%) significant sac expansions, (c) 91 (29%) renal insufficiency (Stage 3 or above CKD), and 33 (10%) iodine contrast allergies. CEUS was compared with CTA, with additional confirmation by angiographic and operative findings in the case of repair in the first 100 patients. CEUS had 100% sensitivity and 100% specificity in classifying endoleaks. No differences in endoleak, re-interventions and sac shrinkage percentage were seen between the two groups at 4 years. A 4 year analysis of CTA use found a 90% reduction with the introduction of CEUS. |
2 |
| 93. Rouet L, Dufour C, Collet Billon A, Bredahl K. CT and 3D-ultrasound registration for spatial comparison of post-EVAR abdominal aortic aneurysm measurements: A cross-sectional study. Computerized Medical Imaging & Graphics. 73:49-59, 2019 04. |
Review/Other-Dx |
52 patients |
To provide a methodology to register volumes of stented abdominal aortic aneurysm, imaged by 3D-US and CT modalities. |
Results are validated on a database of 52 patients. After registrations, results show a mean inter-planar distance of 6.4 ± 4.5 mm and a mean inter-planar angle of 10.2°±6.7 between CT and 3D-US multi-planar reconstructions. Bland-Altman comparisons of diameter measurements in the CT, US and non-registered volumes are respectively 5.1 ± 2.8, 3.9 ± 2.8, 4.6 ± 3.0 mm. |
4 |
| 94. Zierler RE. Duplex ultrasound follow-up after fenestrated and branched endovascular aneurysm repair (FEVAR and BEVAR). [Review]. Seminars in Vascular Surgery. 33(3-4):60-64, 2020 Dec. |
Review/Other-Dx |
N/A |
To review patients that undergoing duplex ultrasound protocols for follow-up after FEVAR, BEVAR, and F-BEVAR. |
In a review of patients having covered stents placed in non-stenotic renal arteries during FEVAR, both peak systolic velocity and the renal to aortic velocity ratio remained below the standard significant stenosis threshold in most patients. The duplex velocity criteria for stenosis in native renal arteries appeared to overestimate the severity of stenosis in renal artery covered stents. The unstented superior mesenteric artery remained widely patent in the presence of fenestrations or crossing struts and was not associated with endoleaks. |
4 |
| 95. Johnsen L, Hisdal J, Jonung T, Braaten A, Pedersen G. Three-dimensional ultrasound volume and conventional ultrasound diameter changes are equally good markers of endoleak in follow-up after endovascular aneurysm repair. Journal of Vascular Surgery. 75(3):1030-1037.e1, 2022 03. |
Observational-Dx |
92 patients planned for endovascular aneurysm repair |
To evaluate the accuracy and precision of three-dimensional ultrasound aneurysm sac-volume estimates, and to explore whether volume and/or diameter changes on ultrasound can be used as markers of endoleak. |
A total of 79 men and 13 women were included. Mean age was 74 years (57-92 years). Median follow-up was 24 months. Endoleak cases were observed for up to 55 months. Diameter measurements on conventional ultrasound correlated well with CT diameters (r = 0.9, P < .05, n = 347), and Bland-Altman analyses showed an upper limit of agreement of +0.5 cm and a lower limit of agreement of -0.8 cm. The mean difference was -0.13 cm ± 0.36 cm. Three-dimensional ultrasound volumes had a correlation with CTA diameters of r = 0.8 (P < .05, n = 347) and with three-dimensional CT volumes of r = 0.8 (P < .05, n = 155). Receiver operating characteristic analyses showed that the diameter and volume changes that led to reintervention were most accurate at 24-month follow-up, with area-under-the-curve percentage changes of 0.98 (two-dimensional ultrasound), 0.97 (three-dimensional ultrasound), and 0.97 (two-dimensional CT). |
1 |
| 96. Lookstein RA, Goldman J, Pukin L, Marin ML. Time-resolved magnetic resonance angiography as a noninvasive method to characterize endoleaks: initial results compared with conventional angiography. J Vasc Surg. 2004; 39(1):27-33. |
Observational-Dx |
12 patients |
To compare the findings of time-resolved MRA with conventional angiography for the characterization of endoleaks. |
Time-resolved MRA identified 7 patients with type I leaks, including four proximal and three distal. Four patients had type II leaks, including two arising from the inferior mesenteric artery and two from an iliolumbar artery. One patient had a type III leak. Conventional angiography confirmed the type of endoleak in all 12 patients. These initial results demonstrate time-resolved MRA to be an effective noninvasive method for classifying endoleaks. This technique may allow for screening of patients with endoleaks to identify those requiring urgent repair. |
2 |
| 97. Ashoke R, Brown LC, Rodway A, et al. Color duplex ultrasonography is insensitive for the detection of endoleak after aortic endografting: a systematic review. J Endovasc Ther. 2005; 12(3):297-305. |
Meta-analysis |
N/A |
A systematic search to synthesize the available evidence regarding the diagnostic accuracy of color duplex US vs the accepted gold-standard of contrast-enhanced CT for the detection and classification of endoleaks after aortic endografting. |
From meta-analyses, the pooled sensitivity of color duplex US (vs CT as the gold standard) was 69% (95% CI 52%-87%) and the specificity of color duplex US was 91% (95% CI 87%-95%). These parameters did not appear to vary over time when a smaller dataset of 117 patients with 239 paired scans was used to compare CT and color duplex US specifically at 3, 12, and 24 months after endografting. Endoleak classification data, which was derived from only 5 small studies, indicated that color duplex US appeared to have better diagnostic accuracy in detecting type I or type III endoleaks compared with type II endoleaks; however, the data were insufficient for statistical analysis. Color duplex US currently does not have sufficient diagnostic accuracy for the detection of all endoleaks in routine clinical practice. The diagnostic accuracy of color duplex US may improve if type II endoleaks are ignored. |
M |
| 98. Sun Z. Diagnostic value of color duplex ultrasonography in the follow-up of endovascular repair of abdominal aortic aneurysm. J Vasc Interv Radiol. 2006; 17(5):759-764. |
Meta-analysis |
21 studies |
To systematically review the findings of diagnostic value of color duplex US in the follow-up of endovascular repair of AAAs. |
Pooled estimates of sensitivity, specificity, PPV, NPV, and accuracy of color duplex US compared with CTA (with 95% CI) were 66% (52%-81%), 93% (89%-97%), 76% (65%-87%), 90% (86%-95%), and 91% (86%-97%), respectively, for unenhanced color duplex US; and 81% (52%-100%), 82% (68%-97%), 58% (26%-90%), 95% (87%-100%), and 98% (91%-100%), respectively, for enhanced color duplex US. The sensitivity in the detection of endoleak was significantly improved with contrast material-enhanced color duplex US compared with unenhanced color duplex US (P<.05); however, no significant difference was found regarding the specificity, PPV, NPV, and accuracy between unenhanced and enhanced color duplex US (P>.05). Color duplex US was insensitive in measurement of aneurysm diameter compared with CTA in most situations. Color duplex US is not as accurate as CTA and cannot replace CTA in the follow-up of endovascular aortic repair of AAAs. However, the use of contrast material-enhanced color duplex US resulted in improvement of diagnostic accuracy in the detection of endoleak and warrants further study. |
M |
| 99. Gabriel M, Tomczak J, Snoch-Ziolkiewicz M, et al. Superb Micro-vascular Imaging (SMI): a Doppler ultrasound technique with potential to identify, classify, and follow up endoleaks in patients after Endovascular Aneurysm Repair (EVAR). Abdominal Radiology. 43(12):3479-3486, 2018 12. |
Observational-Dx |
30 patients underwent post-EVAR follow-up with Color Doppler Ultrasound (CDUS), CEUS, SMI, and CTA |
To assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR). |
CTA revealed fifteen endoleaks (50%): three type Ia, nine type II, and three type III. The sensitivity of CDUS, CEUS, and SMI relative to CTA was 27%, 100%, and 100%, respectively. Specificity was 93%, 93%, and 93%, respectively. Accuracy was 60%, 97%, and 97%, respectively. There were no differences between SMI and CEUS in terms of sensitivity, specificity, or accuracy (100%, 93%, and 97%). We do not observe statistically significant differences between CTA, CEUS, and SMI concerning endoleak identification ability. The weakest method in endoleak identification was CDUS. |
1 |
| 100. Faccioli N, Foti G, Casagranda G, Santi E, D'Onofrio M. CEUS versus CT Angiography in the follow-up of abdominal aortic endoprostheses: diagnostic accuracy and activity-based cost analysis. Radiologia Medica. 123(12):904-909, 2018 Dec. |
Observational-Dx |
137 patients in post-EVAR follow-up |
To evaluate diagnostic accuracy and to perform an activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) compared to computed tomography (CT) during annual surveillance after abdominal aortic aneurysm repair with endovascular procedure (EVAR). |
CEUS reported accuracy, sensitivity, specificity, positive predictive values, negative predictive values of 97.4, 96, 100, 100 and 93.1% in the detection and characterization of endoleaks. CEUS cost was € 84.7, and CTA cost was € 157.77, with a differential cost of € 73.07; using CEUS as an alternative to CT allowed a potential saving of 50.052,95 € during follow-up. |
2 |
| 101. Jean-Baptiste E, Feugier P, Cruzel C, et al. Computed Tomography-Aortography Versus Color-Duplex Ultrasound for Surveillance of Endovascular Abdominal Aortic Aneurysm Repair: A Prospective Multicenter Diagnostic-Accuracy Study (the ESSEA Trial). Circulation. Cardiovascular imaging. 13(6):e009886, 2020 06. |
Observational-Dx |
659 post-EVAR patients |
To assess the diagnostic accuracy of DUS as an alternative to CTA for the follow-up of post-EVAR patients. |
This study recruited prospectively 659 post-EVAR patients of whom 539 (82%) were eligible for further analysis. Following the baseline inclusion visit, 940 additional follow-up visits were performed in the 539 patients. Major aneurysm-related morphological abnormalities were revealed by CTA in 103 patients (17.2/100 person-years [95% CI, 13.9-20.5]). DUS accurately identified 40 patients where a major aneurysm-related morphological abnormality was present (sensitivity, 39% [95% CI, 29-48]) and 403 of 436 patients with negative CTA (specificity, 92% [95% CI, 90-95]). The negative predictive value and positive predictive value of DUS were 92% (95% CI, 90-95) and 39% (95% CI, 27-50), respectively. The positive likelihood ratio was 4.87 (95% CI, 2.9-9.6). DUS sensitivity reached 73% (95% CI, 51-96) in patients requiring an effective reintervention. |
1 |
| 102. Shukla K, Messner M, Albuquerque F, Larson R, Newton D, Levy M. Safety of Utilizing Ultrasound as the Sole Modality of Follow-Up after Endovascular Aneurysm Repair. Annals of Vascular Surgery. 92:172-177, 2023 May. |
Review/Other-Dx |
85 EVAR patients |
To report the results of a single institution’s retrospective analysis of EVAR patient outcomes over a span of 10 years who underwent their initial surveillance with DUS. |
Eighty-five of the 213 EVAR patients (39.9%) were lost to FU within 3 months. Among the 128 remaining patients, 91 underwent FU using initial US, while 37 patients underwent post-EVAR FU initially using CTA. There were no significant differences (P > 0.05) between patient age (75.5 ± 9.4 vs. 75.3 ± 8.5), body mass index (BMI) (27.7 ± 5.4 vs. 28.9 ± 7.4), or mean AAA size (5.6 ± 1.1 vs. 5.9 ± 1.2) in US-surveilled and computed tomography (CT)-surveilled groups, respectively. Of the 91 patients, initially surveilled with US, 15 patients demonstrated endoleak and/or AAA growth (>5 mm). The 15 patients with US-demonstrated endoleak and/or growth underwent confirmatory CTA, with 3 patients eventually requiring EVAR revision. Among 37 patients initially surveilled with CT, 10 demonstrated significant growth and 2 patients eventually required EVAR revision. There were no patients with AAA rupture during post-EVAR surveillance. FU data were analyzed among a select lower-risk group of patients (preoperative AAA diameter =5.5 cm, BMI =30, and no endoleak at completion of EVAR). Among this group, there were no surveilled patients who required EVAR reintervention, regardless of surveillance modality (US n = 32; CT n = 4). The average FU was 29.5 ± 26.4 months in the US group and 26.4 ± 22.3 months in the CT group (P > 0.05). |
4 |
| 103. Arko FR, Filis KA, Siedel SA, et al. Intrasac flow velocities predict sealing of type II endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003; 37(1):8-15. |
Observational-Dx |
265 patients |
To determine whether intrasac spectral Doppler flow velocities can predict whether or not a type II endoleak will spontaneously seal and to relate intrasac flow to preoperative branch vessel anatomy. |
Spectral Doppler velocities were significantly lower in patients with sealed endoleaks compared with persistent endoleaks (75.5 +/- 78.8 cm/s vs 138.2 +/- 36.2 cm/s; P<.01). Patients with sealed endoleaks and low (<100 cm/s) intrasac Doppler velocities had significantly fewer patent inferior mesenteric arteries (43% vs 81%; P<.01), a smaller inferior mesenteric artery (5.6 +/- 1.8 mm vs 7.2 +/- 1.3 mm; P<.01), and fewer paired lumbar arteries (1.3 +/- 0.8 vs 2.4 +/- 0.6; P<.0001) compared with those with persistent endoleaks and high (>100 cm/s) intrasac flow velocities. Aneurysm diameter (-4.6 +/- 5.6 mm) and volume (-0.9 +/- 45.2 mL) decreased in patients with sealed endoleaks. Aneurysm diameter (1.8 +/- 4.9 mm) and volume (18.5 +/- 33.9 mL) increased slightly in patients with persistent endoleaks (P<.05). Intrasac Doppler velocities can be used to predict whether a type II endoleak will spontaneously seal. High-velocity type II endoleaks are related to preoperative large branch vessel diameter and number and are resistant to endovascular treatment. |
3 |
| 104. Karthikesalingam A, Al-Jundi W, Jackson D, et al. Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair. Br J Surg. 2012;99(11):1514-1523. |
Meta-analysis |
25 Studies |
To review the role of surveillance is to enable the treatment of endograft-related complications that would otherwise lead to aneurysm-related death, there is a need for reappraisal of the diagnostic accuracy of CEUS and DUS, focusing on detection of clinically relevant types 1 and 3 endoleak. |
Twenty-five studies (3975 paired scans) compared DUS with CT for all endoleaks. The pooled sensitivity was 0.74 (95 per cent confidence interval 0.62 to 0.83) and the pooled specificity was 0.94 (0.90 to 0.97). Thirteen studies (2650 paired scans) reported detection of types 1 and 3 endoleak by DUS; the pooled sensitivity of DUS was 0.83 (0.40 to 0.97) and the pooled specificity was 1.00 (0.97 to 1.00). Eleven studies (961 paired scans) compared CEUS with CT for all endoleaks. The pooled sensitivity of CEUS was 0.96 (0.85 to 0.99) and the pooled specificity was 0.85 (0.76 to 0.92). Eight studies (887 paired scans) reported detection of types 1 and 3 endoleak by CEUS. The pooled sensitivity of CEUS was 0.99 (0.25 to 1.00) and the pooled specificity was 1.00 (0.98 to 1.00). |
M |
| 105. Causey MW, Jayaraj A, Leotta DF, et al. Three-dimensional ultrasonography measurements after endovascular aneurysm repair. Ann Vasc Surg. 27(2):146-53, 2013 Feb. |
Observational-Dx |
7 Patients |
To compare the variability in diameter, cross-sectional area (CSA), and volume measurements of abdominal aortic aneurysms obtained using a three-dimensional (3D) US imaging system with those obtained using computed tomographic (CT) angiography, and to determine the reliability of these measures.Intravenous contrast was administered in this study |
The average aneurysm measured 57.2 mm on CT and 56.2 mm on US (P = 0.14). Correlation coefficients for diameter, CSA, and volume were 0.88, 0.90, and 0.93, respectively (all P values < 0.001). A Bland–Altman analysis demonstrated a strong agreement between 92% of the diameter, 96.4% of the CSA, and 100% of the volume measurements. The interrater reliability was remarkably high comparing the modalities (CT vs. US), and ranged from 0.934 to 0.997 for single measurements and 0.965 to 0.998 for all measurements together; moreover, there was a strong reliability when the tests were reviewed 6 to 8 weeks later, with a reliability of 0.962 to 0.998 for single measurements and 0.992 to 0.999 for all tests (all P values < 0.001). |
3 |
| 106. Rubenthaler J, Reiser M, Cantisani V, Rjosk-Dendorfer D, Clevert DA. The value of contrast-enhanced ultrasound (CEUS) using a high-end ultrasound system in the characterization of endoleaks after endovascular aortic repair (EVAR). Clinical Hemorheology & Microcirculation. 66(4):283-292, 2017. |
Observational-Dx |
41 patients |
To evaluate the value of contrast-enhanced ultrasound (CEUS) using a high-end ultrasound system in the characterization of endoleaks after endovascular aortic repair (EVAR). |
41 patients were included in the study. Between June and December 2016, mostly male patients (n = 38; 92,7%) were examined, corresponding to the incidence of abdominal aortic aneurysms in the population. Average age was 75±8 years (range 58-100 years). Average diameter of the treated aneurysm-sacs was 5,04±1.5 cm (range 2.7-10.5 cm) in the right-left plane and 4,75±1.36 cm (range 2.8-8.9 cm) in the ventral-dorsal plane. Using CEUS as the gold standard endoleaks could be detected in 28 patients (68,3%) with 13 patients not showing an endoleak after EVAR. Color Doppler showed a sensitivity of 32.1%, a specificity of 92.3%, a positive predictive value (PPV) of 90.0% and a negative predictive value (NPV) of 38,7% compared to CEUS being the gold standard. |
2 |
| 107. Gifford JN, Cheong HW, Teoh WC. Late-onset type I endoleak characterized by contrast enhanced ultrasound after endovascular repair of aortic aneurysm. Journal of Clinical Ultrasound. 46(6):424-429, 2018 Jul. |
Review/Other-Dx |
1 case |
To report a case of a patient with an intra-abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR) who developed renal impairment during the period of follow up. |
The repair was complicated with an early-onset type II endoleak which later evolved into a late-onset type I endoleak. It was treated with proximal extension of stent graft, with treatment success and follow-up documented on contrast enhanced ultrasound (CEUS). This case illustrates the usefulness of CEUS in post-EVAR surveillance and emphasizes the need for life-long monitoring as late-onset complications are not uncommon. |
4 |
| 108. Murphy M, Hodgson R, Harris PL, McWilliams RG, Hartley DE, Lawrence-Brown MM. Plain radiographic surveillance of abdominal aortic stent-grafts: the Liverpool/Perth protocol. J Endovasc Ther. 2003; 10(5):911-912. |
Review/Other-Dx |
N/A |
To present a protocol for radiographic surveillance of abdominal aortic stent-grafts that addresses the main variables in need of standardization: (1) patient position, (2) radiographic centering point, and (3) focus-to-film distance. |
Evaluation of the radiographs depends on the design of the stent-graft, so it is important to understand graft construction and the position of the radiopaque markers to best assess changes on follow-up films. |
4 |
| 109. Hallett RL, Ullery BW, Fleischmann D. Abdominal aortic aneurysms: pre- and post-procedural imaging. [Review]. Abdominal Radiology. 43(5):1044-1066, 2018 05. |
Review/Other-Dx |
N/A |
To discuss the current role of imaging in the assessment of AAA patients prior to intervention, in evaluation of procedural complications, and in long-term follow-up of EVAR patients. |
No results provided |
4 |
| 110. Postoperative imaging of the aorta. |
Review/Other-Dx |
N/A |
To define the normal postoperative appearance and important complications of various open and endovascular surgical techniques of the thoracic and abdominal aorta. |
No results in abstract. |
4 |
| 111. Pratesi C, Esposito D, Apostolou D, et al. Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). Journal of Cardiovascular Surgery. 63(3):328-352, 2022 Jun. |
Review/Other-Tx |
N/A |
To revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. |
No results in abstract. |
4 |
| 112. Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms. [Review]. Clin Radiol. 67(8):802-14, 2012 Aug. |
Review/Other-Dx |
N/A |
To illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques. |
No results in abstract. |
4 |
| 113. Baba T, Ohki T, Kanaoka Y, et al. Clinical Outcomes of Total Endovascular Aneurysm Repair for Aortic Aneurysms Involving the Proximal Anastomotic Aneurysm following Initial Open Repair for Infrarenal Abdominal Aortic Aneurysm. Annals of Vascular Surgery. 49:123-133, 2018 May. |
Observational-Tx |
24 patients underwent elective endovascular repair for the treatment of AAPAAs |
To evaluate initial and midterm clinical outcomes of aortic aneurysms involving the proximal anastomotic aneurysm (AAPAAs) following initial open repair for infrarenal abdominal aortic aneurysm. |
F-EVAR, t-Branch, and s-EVAR for AAPAAs were performed in 15 patients (62.5%), 5 patients (20.8%), and 4 patients (16.7%), respectively. Type I and type II AAPAA were identified in 13 patients (54.2%) and 7 patients (29.2%), and type III AAPAA was identified in 4 patients (16.7%). Technical success was 95.8%, and clinical success was 79.2% with t-EVAR. Spinal cord ischemia was identified in 2 patients (8.3%) of type I AAPAA, the 30-day mortality rate was 4.2% (n = 1, type I AAPAA). Type II and III endoleaks occurred in 1 (4.2%, type III AAPAA) and 3 patients (12.5%, each case of type I, II, and III AAPAA), respectively. There was no open conversion or aneurysm rupture in the late follow-up period. The estimated overall survival rates of t-EVAR after 1 and 3 years were 95.6% and 76.2%, respectively. Rates of freedom from aneurysm-related death and secondary intervention of t-EVAR at 3 years were 90.1% and 89.7%, respectively. Finally, rates of target vessel patency at 1 and 3 years were 95.3% and 88.8%, respectively. |
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| 114. Charbonneau P, Hongku K, Herman CR, et al. Long-term survival after endovascular and open repair in patients with anatomy outside instructions for use criteria for endovascular aneurysm repair. Journal of Vascular Surgery. 70(6):1823-1830, 2019 12. |
Observational-Tx |
202 EVAR patients and 224 OSR patients |
To compare the long-term survival of EVAR and OSR in patients with anatomy outside IFU criteria for EVAR. |
The study population included 202 EVAR patients and 224 OSR patients with at least one anatomic IFU violation for EVAR. EVAR patients were older (78.1 ± 7.3 vs 70.9 ± 7.0 years; P < .001) and less likely to be hypertensive (69.3% vs 79.0%; P = .02) compared with OSR patients. OSR patients were more likely to have proximal aortic neck IFU violations (75.0% vs 47.1%; P < .001) and were less likely to have iliac IFU violations (65.2% vs 79.2%; P < .001). All-cause mortality was 37.6% in the EVAR group and 24.1% in the OSR group with a median follow-up time of 5.2 (3.5-7.2) and 5.4 (2.8-9.3) years, respectively (P < .002). Kaplan-Meier survival analysis revealed a significant association between patients undergoing OSR and increased long-term survival (log-rank P < .0001). When adjusted for possible confounders and weighted for propensity for treatment through Cox hazard modeling, the association remained significant (hazard ratio, 0.6; 95% confidence interval, 0.4-0.9). Aneurysm-related mortality was 3.5% in the EVAR group and 2.2% in the OSR group during long-term follow-up (P < .001). |
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| 115. Serizawa F, Ohara M, Kotegawa T, Watanabe S, Shimizu T, Akamatsu D. The Incidence of Para-Anastomotic Aneurysm After Open Repair Surgery for Abdominal Aortic Aneurysm Through Routine Annual Computed Tomography Imaging. European Journal of Vascular & Endovascular Surgery. 62(2):187-192, 2021 08. |
Observational-Tx |
147 patients who underwent ORS for AAA |
To estimate the incidence of para-anastomotic aneurysms and reveal secondary complications through routine annual computed tomography (CT) imaging. |
The follow up period was 7.1 ± 2.7 years. The total follow up time of all patients was 1 041.1 years, and 958 CT images were collected (0.92 CT scans/year/patient). A proximal para-anastomotic aneurysm was detected in five patients (3.4%). Four of the five patients had aneurysmal dilation at the initial ORS (proximal diameter >25 mm), which enlarged during follow up; thus, a de novo proximal para-anastomotic aneurysm was observed in one patient (0.7%). The time between surgery and the diagnosis of all proximal para-anastomotic aneurysms was 5.7 ± 1.4 years, and the de novo proximal para-anastomotic aneurysm was detected at 11.8 years. The incidence of all para-anastomotic aneurysms at five and 10 years was 2.2% and 3.6%, and the incidence of the de novo para-anastomotic aneurysm was 0% at five and 10 years. Nine synchronous thoracic aortic aneurysms (TAAs) and seven metachronous TAAs were detected, and 16 patients (10.9%) had a TAA. Neoplasms were detected in 18 of 147 patients (12.2%), and the most dominant neoplasm was lung cancer. |
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