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Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis

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Abstract

Objective

The purpose of this systematic review and meta-analysis was to assess the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) compared to computed tomography angiography (CTA) for the detection of endoleaks within endovascular aortic aneurysm repair (EVAR) surveillance at time of follow up.

Methods

A comprehensive literature search was undertaken among the four major databases (PubMed, Embase, Scopus and Ovid) to identify all articles assessing diagnostic specificity and accuracy with comparative modality (CEUS vs CTA) for endoleaks in adult patients at time of follow-up following EVAR. Databases where evaluated and assessed to October 2018.

Results

A total of 1773 patients were analysed from across 18 included studies in the quantitative analysis of the parameters of interest. There was no significant difference in detection rate of endoleak type I with detection rate 4.3% for both groups OR 1.09, 95% CI [0.78, 1.53], p = 0.62; type II endoleak detection rate was 22% in the CEUS group vs 23% in the CTA group OR 1.16, 95% CI [0.75–1.79], p = 0.50; while type III detection rate was 1.8% in CEUS group vs 2% in CTA group OR 0.85, 95% CI [0.43, 1.68], p = 0.64. However, the sensitivity rate for endoleak detection was higher in CEUS (p = 0.001) while no difference in specificity rate was noted (p = 0.28). There was higher rate of missed endoleaks in CTA groups (n = 12 vs n = 20).

Conclusion

Evidences from this study suggest that contrast-enhanced ultrasound scan post-EVAR can be utilised as safe and effective method in screening for endoleaks during post-EVAR surveillance without exposing the patient for additional risk of radiation and contrast. CEUS conveys no inferiority to CTA in detecting endoleaks.

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Funding

No funding obtained for this study.

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Authors and Affiliations

  1. Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK

    Amer Harky, Ewa Zywicka, Mihika Joshi & Sameh Dimitri

  2. Department of General Surgery, Warrington and Halton NHS Foundation Trust, Warrington, WA5 1QG, UK

    Giovanni Santoro

  3. Department of Cardiac Surgery, Barts Heart Centre, London, EC1A 7BE, UK

    Lucas Jullian

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  1. Amer Harky
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  2. Ewa Zywicka
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  4. Lucas Jullian
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Correspondence to Amer Harky.

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Harky, A., Zywicka, E., Santoro, G. et al. Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis. J Ultrasound 22, 65–75 (2019). https://doi.org/10.1007/s40477-019-00364-7

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  • DOI: https://doi.org/10.1007/s40477-019-00364-7

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