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A Narrative Review on Contrast-Enhanced Ultrasound in Aortic Endograft Endoleak Surveillance

Gummadi, Sriharsha MD*†; Eisenbrey, John R. PhD; Lyshchik, Andrej MD, PhD

doi: 10.1097/RUQ.0000000000000353
Review Article

Endovascular repair of abdominal aortic aneurysms have been performed successfully since 1991. However, 20% to 50% of these patients may develop an endoleak or continued aneurysmal sac expansion or perfusion despite stent graft coverage. Current recommendations suggest lifelong surveillance with computed tomographic angiography (CTA) at least 1 month after intervention and yearly after that. In select patients with a stable aneurysm sac on computed tomography performed 1 year after treatment, future screening could be performed with ultrasonography. However, color Doppler ultrasound can fail to detect as many as 31% of endoleaks. Contrast-enhanced ultrasound (CEUS) provides an alternative approach to excluded aneurysm sac follow-up imaging. The Society for Vascular Surgery notes a need for further research on the role of CEUS in endovascular aortic repair surveillance. The European Federation of Societies for Ultrasound in Medicine and Biology suggests that early results are promising. Meta-analyses report pooled sensitivities and specificities of CEUS compared with CTA for the detection of endoleak between 89% and 98% and 86% and 88%, respectively. Owing to the dynamic flow information it provides, CEUS may actually be more sensitive than CTA at detection and characterization in select circumstances. Challenges with adoption, patient selection, and operator dependency remain, but current and future research suggests a role for CEUS in endoleak surveillance.

*Department of Surgery, Lankenau Medical Center, Wynnewood; and

Department of Radiology, Thomas Jefferson University, Philadelphia PA.

Received for publication January 9, 2018; accepted February 7, 2018.

Address correspondence to: Sriharsha Gummadi, MD, Thomas Jefferson University, 132 South 10th Street, Suite 767, Main Building, Philadelphia PA 19107 (e-mail:

Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number R01CA194307.

The authors report nonfinancial and grant support from GE Healthcare and Toshiba Medical Systems outside the submitted work.

Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Because all clinical vignettes contain only de-identified retrospective data and are used for educational purposes only, no consent outside standard procedural consent was requested of any patients.

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