ABSTRACT
Background: The aim of this study was to assess whether contrast-enhanced ultrasound (CEUS) shows a false negative rate close to zero and therefore is suitable as the main non-invasive follow-up strategy for long-term monitoring after endovascular aortic repair (EVAR). Methods: We included all consecutive patients who underwent CEUS as follow-up after EVAR at our center between January 2017 and December 2021.The follow-up protocol consisted of Duplex ultrasound (DUS) with CEUS at 1, 3, 6 months postoperatively and every 6 months thereafter. Results: A total of 125 patients underwent 228 CEUS. The aneurysm sac showed shrinkage in 80 (64%) patients, stability in 32 (25.6%), and enlargement in 13 (10.4%). A total of 29 (23.2%) patients showed type 2 endoleak, 6 (4.8%) patients showed type 1 endoleak and 3 (2.4%) patients showed type 3 endoleak. Thirteen patients underwent one or more reinterventions. The sensitivity of CEUS vs. DUS was 100% vs. 75% (p > 0.0001). In classifying type 2 endoleak, CEUS compared to DUS showed a sensitivity of 93.2% vs. 59.4% and a specificity of 99.3% vs. 99.3%. CEUS showed a higher sensitivity compared to DUS in the detection of type 2 endoleak. CEUS permits the identification of a subset of patients requiring a stricter follow-up protocol.
ABSTRACT
Human brucellosis is a disease of protean manifestations, and has been implicated in complications and focal disease in many human organ systems. However, little is collectively known about the background, the course, the clinical characteristics, the diagnostic issues raised, and the short- and long-term therapeutic approaches in patients with aortic involvement as a complication of brucellosis. With the aim to glean from the literature useful information to better understand and manage this complication, a computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patients with involvement of the aorta due to a Brucella infection. The epidemiologic and clinical characteristics of 44 cases of brucellar aortic involvement found through the systematic review of the literature were analyzed together with those of two new cases that we treated in the recent past. This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter it was associated with spondylodiscitis of the lumbar spine in 13 cases. History of or symptoms indicative of brucellosis were not universally present. Brucellar aortic involvement represents a possibly underdiagnosed and underreported complication with major morbidity and mortality potential. Experience with novel invasive therapeutic approaches remains limited. Early suspicion through detailed history and diagnosis, aided by advances in aortic imaging, would allow for better planning of therapeutic interventions.
