Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.

Hdl Handle:
http://hdl.handle.net/10147/207792
Title:
Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.
Authors:
Manning, Brian J; O'Neill, Sean M; Haider, Syed N; Colgan, Mary P; Madhavan, Prakash; Moore, Dermot J
Affiliation:
Department of Vascular and Endovascular Surgery, St James Hospital, Dublin,, Ireland. brianjmanning@gmail.com
Citation:
J Vasc Surg. 2009 Jan;49(1):60-5. Epub 2008 Oct 1.
Journal:
Journal of vascular surgery : official publication, the Society for Vascular, Surgery [and] International Society for Cardiovascular Surgery, North American, Chapter
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207792
DOI:
10.1016/j.jvs.2008.07.079
PubMed ID:
18829237
Abstract:
OBJECTIVES: Cumulative radiation dose, cost, and increased demand for computed tomography aortography (CTA) suggest that duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up. METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleak detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa. RESULTS: One hundred thirty-two patients underwent EVAR, of whom 117 attended for follow-up ranging from six months to nine years (mean, 32 months). Adequate aneurysm sac visualisation on DU was not possible in 1.7% of patients, predominantly due to obesity. Twenty-eight endoleaks were detected in 28 patients during follow-up. Of these, 24 were initially identified on DU (four false negative DU examinations), and eight had at least one negative CTA with a positive DU prior to diagnosis. Twenty-three endoleaks were type II in nature and three of these patients had increased sac size. There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5 mm or more at follow-up, five had an endoleak visible on DU, yet negative CTA and a further five had endoleak visualisation on both DU and CTA. Of six endoleaks which underwent re-intervention, all were initially picked up on DU. One of these endoleaks was never demonstrated on CTA and a further two had at least one negative CTA prior to endoleak confirmation. Positive predictive value for DU was 45% and negative predictive value 94%. Specificity of DU for endoleak detection was 67% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 86%, with all clinically significant endoleaks demonstrated on CTA also detected on DU. CONCLUSION: Despite its low positive predictive value, we found DU to be a sensitive test for the detection of clinically significant endoleaks. Given concerns about cumulative radiation exposure and cost, and the surprisingly low sensitivity of CTA for endoleak detection in this series, selective CTA based on DU surveillance may be a more appropriate long-term strategy.
Language:
eng
MeSH:
Aged; Aged, 80 and over; Angiography, Digital Subtraction; Aortic Aneurysm/*radiography/surgery/*ultrasonography; Aortography/*methods; *Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation/adverse effects/*instrumentation; Databases as Topic; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Prosthesis Failure; Radiation Dosage; Reoperation; Sensitivity and Specificity; *Tomography, X-Ray Computed; Treatment Outcome; *Ultrasonography, Doppler, Color
ISSN:
1097-6809 (Electronic); 0741-5214 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorManning, Brian Jen_GB
dc.contributor.authorO'Neill, Sean Men_GB
dc.contributor.authorHaider, Syed Nen_GB
dc.contributor.authorColgan, Mary Pen_GB
dc.contributor.authorMadhavan, Prakashen_GB
dc.contributor.authorMoore, Dermot Jen_GB
dc.date.accessioned2012-02-01T10:44:51Z-
dc.date.available2012-02-01T10:44:51Z-
dc.date.issued2012-02-01T10:44:51Z-
dc.identifier.citationJ Vasc Surg. 2009 Jan;49(1):60-5. Epub 2008 Oct 1.en_GB
dc.identifier.issn1097-6809 (Electronic)en_GB
dc.identifier.issn0741-5214 (Linking)en_GB
dc.identifier.pmid18829237en_GB
dc.identifier.doi10.1016/j.jvs.2008.07.079en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207792-
dc.description.abstractOBJECTIVES: Cumulative radiation dose, cost, and increased demand for computed tomography aortography (CTA) suggest that duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up. METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleak detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa. RESULTS: One hundred thirty-two patients underwent EVAR, of whom 117 attended for follow-up ranging from six months to nine years (mean, 32 months). Adequate aneurysm sac visualisation on DU was not possible in 1.7% of patients, predominantly due to obesity. Twenty-eight endoleaks were detected in 28 patients during follow-up. Of these, 24 were initially identified on DU (four false negative DU examinations), and eight had at least one negative CTA with a positive DU prior to diagnosis. Twenty-three endoleaks were type II in nature and three of these patients had increased sac size. There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5 mm or more at follow-up, five had an endoleak visible on DU, yet negative CTA and a further five had endoleak visualisation on both DU and CTA. Of six endoleaks which underwent re-intervention, all were initially picked up on DU. One of these endoleaks was never demonstrated on CTA and a further two had at least one negative CTA prior to endoleak confirmation. Positive predictive value for DU was 45% and negative predictive value 94%. Specificity of DU for endoleak detection was 67% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 86%, with all clinically significant endoleaks demonstrated on CTA also detected on DU. CONCLUSION: Despite its low positive predictive value, we found DU to be a sensitive test for the detection of clinically significant endoleaks. Given concerns about cumulative radiation exposure and cost, and the surprisingly low sensitivity of CTA for endoleak detection in this series, selective CTA based on DU surveillance may be a more appropriate long-term strategy.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshAngiography, Digital Subtractionen_GB
dc.subject.meshAortic Aneurysm/*radiography/surgery/*ultrasonographyen_GB
dc.subject.meshAortography/*methodsen_GB
dc.subject.mesh*Blood Vessel Prosthesisen_GB
dc.subject.meshBlood Vessel Prosthesis Implantation/adverse effects/*instrumentationen_GB
dc.subject.meshDatabases as Topicen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPredictive Value of Testsen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshProsthesis Failureen_GB
dc.subject.meshRadiation Dosageen_GB
dc.subject.meshReoperationen_GB
dc.subject.meshSensitivity and Specificityen_GB
dc.subject.mesh*Tomography, X-Ray Computeden_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.mesh*Ultrasonography, Doppler, Coloren_GB
dc.titleDuplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.en_GB
dc.contributor.departmentDepartment of Vascular and Endovascular Surgery, St James Hospital, Dublin,, Ireland. brianjmanning@gmail.comen_GB
dc.identifier.journalJournal of vascular surgery : official publication, the Society for Vascular, Surgery [and] International Society for Cardiovascular Surgery, North American, Chapteren_GB
dc.description.provinceLeinster-

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