Which Mode Of Color Doppler Ultrasound Is The Most Suitable For Detecting Endoleak In Surveillance After Endovascular Repair?
Mustafa Daglı, Bekir Bogachan Akkaya, Mehmet Karahan, Hamdi Mehmet Ozbek, Ece Celikten, Boran Tumer, Ertekin Utku Unal, Hakkı Zafer Iscan.
Ankara City Hospital, Ankara, Turkey.
Objective As the endovascular procedures carries its own potential complications and aneurysm related events has not completely vanished, lifelong surveillance is obligatory. For surveillance colored Doppler ultrasound is a standard method of noninvasive evaluation having the advantages of availability, cost-effectiveness and possessing no harm for the patient. We investigated the accuracy of the two noninvasive tests; colored Doppler ultrasound (CDUS) and blood flow image (BFI) each separately and in combination by comparing with computerized tomographic angiography (CTA) as a reference standard. Methods Between January 2018 and December 2019, we prospectively organized a follow-up protocol between Radiology and Cardiovascular Surgery Departments, performing firstly CDUS with BFI and colored Doppler modes separately and then CTA to elective standard EVAR patients. Consecutive 70 patients having an average age of 68,5±7,8 years were evaluated. Results Among the patients, there were 10 detected endoleaks (14,3%) with CTA and 6 with CDUS. CDUS was not able to detect four type II endoleaks, however all type I and III endoleaks were detected perfectly in high correlation (r=0,709). There was a lack in detecting low flow in BFI and standard colored Doppler modes. Eliminating this imperfection, there was a strong correlation of aneurysm sac diameter measurement between CTA and CDUS. The measurements of aneurysm sac were 57,7 mm for CDUS and 59,7 mm for CTA. There was a very high correlation at sac measurements (r=0,949). The sensitivity and specifity of both BFI, color Doppler and combination were the similar (respectively 60% and 100%). The accuracy of both tests and combination was 94,3%. Conclusions Both noninvasive tests showing no superiority to each other. However, BFI is much clearer and more demonstrable eliminating the need of experience for the CDUS operator. For surveillance, CDUS promises accurate results without missing any potential complication requiring intervention as Type I or III endoleaks. Lack of detecting type II endoleaks may be negligible as these kinds of complications requires intervention according to sac enlargement and CDUS has very high correlation with CTA for sac dimensions.
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