Der Radiologe

, 49:1033

Kontrastmittelverstärkter Ultraschall im Follow-up nach endovaskulärer Stentversorgung eines infrarenalen Bauchaortenaneurysmas

  • D.-A. Clevert
  • A. Horng
  • R. Kopp
  • K. Schick
  • G. Meimarakis
  • W.H. Sommer
  • M. Reiser
Leitthema

Zusammenfassung

Der Nachweis oder Ausschluss von Endoleaks nach endovaskulärer Aneurysmaoperation (EVAR) der infrarenalen Aorta stellt eine schwierige diagnostische Herausforderung dar. Die kontrastmittelverstärkte Sonographie (CEUS) ist eine neue und viel versprechende Methode für die Diagnose und die Verlaufskontrolle von Endoleaks. Die CEUS mit dem Kontrastmittel SonoVue® ermöglicht eine schnelle, nichtinvasive Diagnostik im Follow-up nach endovaskulärer Therapie des infrarenalen Bauchaortenaneurysmas. Sensitivität und Spezifität des konventionellen Ultraschalls im Vergleich zur Multislice-CT-Angiographie (MS-CTA) werden mit 33–63 bzw. 63–93% angegeben. Diese Werte können durch den Einsatz der CEUS auf 98–100% (Sensitivität) bzw. 82–93% (Spezifität) gesteigert werden. Dieser Beitrag beschreibt die Ätiologien, die Klassifikation und Bedeutung von Endoleaks und deren Auffindbarkeit mit Hilfe von CEUS.

Schlüsselwörter

Kontrastmittelverstärkte Sonographie (CEUS) Bauchaortenaneurysma (BAA) Endovaskuläre Aneurysmaoperation (EVAR) Endoleak 

Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS)

Abstract

Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue® allows a rapid and non-invasive diagnosis in the follow-up after EVAR. The sensitivity and specificity of conventional ultrasound compared to the multislice CT angiography is estimated to be 33–63% and 63–93%, respectively. These values can be increased through the use of CEUS in up to 98–100% (sensitivity) and 82–93% (specificity). This article describes the etiology, classification and importance of different types of endoleaks. The value of CEUS in this clinical scenario will be discussed.

Keywords

Contrast-enhanced ultrasound (CEUS) Abdominal aortic aneurysm (AAA) Endovascular aneurysm repair (EVAR) Endoleak 

Literatur

  1. 1.
    Arko FR, Rubin GD, Johnson BL et al (2001) Type-II endoleaks following endovascular AAA repair: preoperative predictors and long-term effects. J Endovasc Ther 8:503–510CrossRefPubMedGoogle Scholar
  2. 2.
    Bargellini I, Napoli V, Petruzzi P et al (2004) Type II lumbar endoleaks: hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular aneurysm repair. J Vasc Surg 41:10–13CrossRefGoogle Scholar
  3. 3.
    Bauer A, Solbiati L, Weissmann N (2002) Ultrasound imaging with SonoVue: low mechanical index realtime imaging. Acad Radiol 9 [suppl 2]:282–284Google Scholar
  4. 4.
    Baum RA, Carpenter JP, Stavropoulous SW, Fairman RM (2001) Diagnosis and management of type 2 endoleaks after endovascular aneurysm repair. Tech Vasc Interv Radiol 4:222–226CrossRefPubMedGoogle Scholar
  5. 5.
    Bendick PJ, Bove BG, Long GW et al (2003) Efficacy of ultrasound scan contrast agents in the noninvasive follow-up of aortic stent grafts. J Vasc Surg 37:381–385CrossRefPubMedGoogle Scholar
  6. 6.
    Chuter TA, Faruqi RM, Sawhney R et al (2001) Endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 34:98–105CrossRefPubMedGoogle Scholar
  7. 7.
    Clevert D-A, Stickel M, Johnson T et al (2007) Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 17(11):2991–3000CrossRefPubMedGoogle Scholar
  8. 8.
    Clevert D-A, Weckbach S, Kopp R et al (2008) Imaging of artic lesions with color coded duplex sonography and contrast-enhanced ultrasound versus multislice computed tomography (MS-CT) angiography. Clin Hemorheol Microcirc 40(4):267–279PubMedGoogle Scholar
  9. 9.
    Clevert D-A, Stickel M, Strautz TI et al (2007) Contrast enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment. Cardiovasc Intervent Radiol 30(3):480–484CrossRefPubMedGoogle Scholar
  10. 10.
    Clevert D-A, Minaifar N, Weckbach S et al (2008) Color duplex ultrasound and contrast-enhanced ultrasound in comparison to MS-CT in the detection of endoleak following endovascular aneurysm repair. Clin Hemorheol Microcirc 39(1–4):121–132Google Scholar
  11. 11.
    Cuypers P, Buth J, Harris PL et al (1999) Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms: results of a European multicenter registry. Eur J Vasc Endovasc Surg 17:507–516CrossRefPubMedGoogle Scholar
  12. 12.
    Franks SC, Sutton AJ, Brtown MJ, Sayers RD (2007) Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Endovasc Surg 33:154–171CrossRefGoogle Scholar
  13. 13.
    Giannoni MF, Palombo G, Sbarigia E et al (2003) Contrast-enhanced ultrasound imaging for aortic stent-graft surveillance. J Endovasc Ther 10(2):208–217CrossRefPubMedGoogle Scholar
  14. 14.
    Golzarian J, Dussaussois L, Abada HT et al (1998) Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR Am J Roentgenol 171:329–331PubMedGoogle Scholar
  15. 15.
    Henao EA, Hodge MD, Felkai DD et al (2006) Contrast-enhanced duplex surveillance after endovascular abdominal aortic aneurysm repair: improved efficacy using a continuous infusion technique. J Vasc Surg 43(2):259–264CrossRefPubMedGoogle Scholar
  16. 16.
    Greis C (2004) Technology overview: SonoVue (Bracco, Milan). Eur Radiol 14 [suppl 8]:11–15Google Scholar
  17. 17.
    Hiatt MD, Rubin GD (2004) Surveillance for endoleaks: how to detect all of them. Semin Vasc Surg 17(4):268–278CrossRefPubMedGoogle Scholar
  18. 18.
    Iezzi R, Basilico R, Giancristofaro D et al (2009) Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair. J Vasc Surg 49(3):552–560CrossRefPubMedGoogle Scholar
  19. 19.
    Kopp R, Weckbach S, Minaifar N et al (2008) Verlaufskontrolle nach endovaskulärer Therapie des infrarenalen Aortenaneurysmas. Gefässchirurgie 13:410–416CrossRefGoogle Scholar
  20. 20.
    Lencioni R, Cioni D, Bartolozzi C (2002) Tissue harmonic and contrast-specific imaging: back to grey-scale in ultrasound. Eur Radiol 12:151–161CrossRefPubMedGoogle Scholar
  21. 21.
    McWilliams RG, Martin J, White D et al (1999) Use of contrast-enhanced ultrasound in follow-up after endovascular aortic aneurysm repair. J Vasc Interv Radiol 10(8):1107–1114CrossRefPubMedGoogle Scholar
  22. 22.
    McWilliams RG, Martin J, White D et al (2002) Detection of endoleak with enhanced ultrasound imaging: comparison with biphasic computed tomography. J Endovasc Ther 9(2):170–179CrossRefPubMedGoogle Scholar
  23. 23.
    Napoli V, Bargellini I, Sardella SG et al (2004) Abdominal aortic aneurysm: contrast-enhanced us for missed endoleaks after endoluminal repair. Radiology 233:217–225CrossRefPubMedGoogle Scholar
  24. 24.
    Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499CrossRefPubMedGoogle Scholar
  25. 25.
    Petrik PV, Moore WS (2001) Endoleaks following endovascular repair of abdominal aortic aneurysm: the predictive value of preoperative anatomic factors – a review of 100 cases. J Vasc Surg 33:739–744CrossRefPubMedGoogle Scholar
  26. 26.
    Schermerhorn ML, O’Malley AJ, Jhaveri A et al (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the medicare population. N Engl J Med 358:464–474CrossRefPubMedGoogle Scholar
  27. 27.
    Thompson MM, Boyle JR, Hartshorn T et al (1998) Comparison of computed tomography and duplex imaging in assessing aortic morphology following endovascular aneurysm repair. Br J Surg 85:346–350CrossRefPubMedGoogle Scholar
  28. 28.
    Thurnher S, Cejna M (2002) Imaging of aortic stent-grafts and endoleaks. Radiol Clin North Am 40:799–833CrossRefPubMedGoogle Scholar
  29. 29.
    Veith FJ, Baum RA, Ohki T et al (2002) Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 35:1029–1035CrossRefPubMedGoogle Scholar
  30. 30.
    Veith FJ, Baum RA (2002) Endoleak and endotension: current consensus on their nature and significance. Dekker, New YorkGoogle Scholar
  31. 31.
    White GH, Yu W, May J et al (1997) Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 4:152–168CrossRefPubMedGoogle Scholar
  32. 32.
    White GH, May J, Waugh RC et al (1998) Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surg 5:305–309CrossRefPubMedGoogle Scholar
  33. 33.
    White GH, May J, Waugh RC, Yu W (1998) Type I and type II endoleaks: a more useful classification for reporting results of endoluminal AAA repair (letter). J Endovasc Surg 5:189–191CrossRefPubMedGoogle Scholar
  34. 34.
    White GH, Yu W, May J (1996) Endoleak – a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg 3:124–125CrossRefPubMedGoogle Scholar
  35. 35.
    White RA (2000) Endograft surveillance: a priority for long-term device performance. J Endovasc Ther 7:522CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • D.-A. Clevert
    • 1
  • A. Horng
    • 1
  • R. Kopp
    • 2
  • K. Schick
    • 3
  • G. Meimarakis
    • 3
  • W.H. Sommer
    • 1
  • M. Reiser
    • 1
  1. 1.Institut für Klinische RadiologieKlinikum der Ludwig-Maximilians-Universität, Campus GrosshadernMünchenDeutschland
  2. 2.Klinik für Allgemein-, Viszeral- und GefäßchirurgieStädtisches Klinikum München, Klinikum München-HarlachingMünchenDeutschland
  3. 3.Chirurgische Klinik und PoliklinikKlinikum der Ludwig-Maximilians-Universität, Campus GrosshadernMünchenDeutschland

Personalised recommendations