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The Usefulness of Contrast-Enhanced Ultrasound for Surveillance of Endoleak after Endo-vascular Aneurysm Repair
J Surg Ultrasound 2019;6:33-37
Published online November 30, 2019
© 2019 The Korean Surgical Ultrasound Society

Shi Jin Cho, Soo Kyung Kwon, Da Mi Jung, Sun Chul Park, Hyang Kyung Kim, Jang Yong Kim, Sang Seob Yun

Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Sang Seob Yun
Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-2876
Fax: +82-2-595-2822
Received October 1, 2019; Revised October 29, 2019; Accepted November 5, 2019.
Journal of Surgical Ultrasound is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open repair for patients with abdominal aortic aneurysm (AAA). Yet the follow-up after EVAR with lifelong post-interventional imaging is mandatory in order to detect complications such as endoleaks or stent migration. Computed tomography angiography (CTA) is considered the standard imaging modality and widely used for follow-up, although patients are exposed to both radiation and nephrotoxic contrast medium. The aim of this study was to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) for detecting post EVAR endoleaks compared with that of CTA, which is considered as the gold standard.
Methods: From January 2010 to August 2019, 27 patients who underwent CEUS and CTA for follow-up after elective EVAR at a single center were retrospectively analyzed. The presence of endoleak was compared between CTA and CEUS.
Results: The 27 paired CTA and CEUS studies were analyzed. Eleven patients had endoleak detected on CEUS and they had the same findings with CTA. One patient had endoleak detected on CEUS, but this was not detected on CTA. Three patients didn’t have endoleak detected on CEUS, but endoleak was detected on CTA. 13 patients had no endoleak detected on CEUS or CTA. Assuming CTA is the gold standard, the sensitivity and specificity of CEUS to detect endoleak were 92.3%, and 78.6% respectively.
Conclusion: CEUS can be used as a viable and feasible imaging alternative for the follow-up and the detection of endoleak after EVAR with the additional benefit of being a real-time non-ionizing radiation examination.
Keywords : Abdominal aortic aneurysm, Contrast enhanced ultrasound, Endovascular abdominal aortic aneurysm repair

November 2019, 6 (2)