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Intraoperative contrast-enhanced ultrasound examination for endoleak detection after complex and infrarenal endovascular aortic repair.
Keschenau, Paula R; Alkassam, Hussam; Kotelis, Drosos; Jacobs, Michael J; Kalder, Johannes.
Afiliação
  • Keschenau PR; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
  • Alkassam H; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
  • Kotelis D; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
  • Jacobs MJ; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, AZM Maastricht, Maastricht, The Netherlands. Electronic address:
  • Kalder J; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
J Vasc Surg ; 71(4): 1200-1206, 2020 04.
Article em En | MEDLINE | ID: mdl-31492615
ABSTRACT

OBJECTIVE:

The aim of this pilot study was to evaluate intraoperative contrast-enhanced ultrasound (iCEUS) examination for endoleak (EL) detection after complex endovascular aortic repairs (EVAR) in comparison with the standard angiographic completion control.

METHODS:

Twenty-one patients (16 male; median age, 73 years [range, 54-81 years]) who underwent single-stage EVARs at our center between October 2016 and October 2018 were included prospectively. The procedures comprised fenestrated and/or branched EVAR (n = 14; 66%), infrarenal EVAR (n = 5; 24%), infrarenal EVAR with bilateral iliac side branch implantation (n = 1; 5%), and infrarenal EVAR with occluder implantation into the internal iliac artery (n = 1; 5%). The used endografts included 14 custom made devices (Cook, Australia Pty Ltd, Brisbane, Australia, n = 6; Vascutek Terumo, Glasgow, Scotland, n = 8) and seven standard infrarenal endografts (Medtronic Inc, Santa Rosa, Calif, n = 5; Vascutek Terumo, Glasgow, Scotland, n = 1; Cook, n = 1). All patients underwent an angiographic completion control for EL detection followed by iCEUS examination. The iCEUS examination was performed by the same examiner who was blinded to the angiography result. In addition to the comparison of the angiographic results to iCEUS examination, iCEUS examination was also compared with the computed tomography angiography (CTA) before discharge (median time to CTA, 5 days [range, 1-7 days]).

RESULTS:

Angiography detected eight type II EL, defining the EL origin in four cases. In addition to detecting all of those eight EL, iCEUS examination revealed eight more type II EL not seen on angiography (P = .002) and allowed a definition of the EL origin in all cases. CTA before discharge showed a persistence of only 5 of the 16 type II EL detected by iCEUS examination (31%, P = .002).

CONCLUSIONS:

An iCEUS examination can be used as another adjunct to decrease exposure to contrast agent and radiation during EVAR, including complex procedures. A replacement of the completion angiography by iCEUS examination is conceivable for infrarenal EVAR, but also for endovascular type IV or type V repairs. Future studies with larger patient numbers will help to further validate iCEUS examination during complex EVAR.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Ultrassonografia / Aneurisma da Aorta Abdominal / Endoleak / Procedimentos Endovasculares Tipo de estudo: Diagnostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Alemanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Ultrassonografia / Aneurisma da Aorta Abdominal / Endoleak / Procedimentos Endovasculares Tipo de estudo: Diagnostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Alemanha