Detection of endoleak with enhanced ultrasound imaging: comparison with biphasic computed tomography.

PURPOSE: To compare unenhanced and enhanced ultrasound imaging to biphasic computed tomography (CT) in the detection of endoleak after endovascular abdominal aortic aneurysm (AAA) repair. METHODS: Fifty-three patients (44 men; mean age 70 years) were examined during 96 follow-up visits after endovascular AAA repair. All patients had color Doppler and power Doppler ultrasound studies performed before and after the administration of an ultrasound contrast agent. Biphasic (arterial and delayed) CT was performed on the same day, and the ultrasound and CT studies were independently scored to record the presence or absence of endoleak and the level of confidence in the observation. RESULTS: The sensitivity of the ultrasound techniques to detect endoleak improved with the use of ultrasound contrast media, ranging from a low of 12% with unenhanced color Doppler to 50% with enhanced power Doppler. However, the enhanced power Doppler failed to detect 9 type II endoleaks identified by CT (86% negative predictive value for endoleak). There were only 2 graft-related endoleaks in the study; one was diagnosed from the ultrasound image, but the other had nondiagnostic ultrasound scans because of poor views. CONCLUSIONS: Ultrasound scanning with or without contrast enhancement was not as reliable as CT in diagnosing type II endoleak. CT imaging remains our surveillance modality of choice.

Percutaneous thrombin injection of carotid artery pseudoaneurysm.

PURPOSE: To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection. CASE REPORT: A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications. CONCLUSIONS: Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.