Angio PLanewave UltraSensitive Imaging (Angio PL.U.S.) as an Innovative Doppler Ultrasound Technique with a Potential to follow up Endoleaks after Endovascular Aneurysm Repair (EVAR).

The aim of the study was to evaluate the effectiveness of Angio PLanewave UltraSensitive imaging (Angio PL.U.S.) as an alternative to contrast-enhanced ultrasound (CEUS) and computed tomography angiography (CTA) for endoleak detection and classification in patients after endovascular aneurysm repair. A total of 28 patients underwent a post-endovascular aneurysm repair follow-up with color Doppler ultrasound, power Doppler ultrasound, CEUS, Angio PL.U.S and CTA examinations. CTA revealed 17 endoleaks in 14 patients (50%): 3 type Ia, 13 type II and 1 type III. There were no differences between Angio PL.U.S. and CEUS in terms of sensitivity, specificity or accuracy (93%, 100% and 97%). We did not observe any statistically significant differences between CTA, CEUS and Angio PL.U.S. in terms of the endoleak identification ability. Angio PL.U.S. may be considered as a potential tool to follow-up patients after endovascular aneurysm repair implantation, especially in patients who cannot be examined with CTA or CEUS.

Superb Micro-vascular Imaging (SMI): a Doppler ultrasound technique with potential to identify, classify, and follow up endoleaks in patients after Endovascular Aneurysm Repair (EVAR).

PURPOSE: The aim of the study was to assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: From May 2015 to January 2017, 30 patients underwent post-EVAR follow-up with Color Doppler Ultrasound (CDUS), CEUS, SMI, and CTA examinations. Aneurysmal sac diameter and graft patency were evaluated; endoleaks were identified and classified. Sensitivity, specificity, and accuracy values were calculated for each of the four diagnostic methods of endoleak detection. A percentage of agreement and Cohen's Kappa coefficient were calculated for comparison of methods in terms of endoleak identification. RESULTS: CTA revealed fifteen endoleaks (50%): three type Ia, nine type II, and three type III. The sensitivity of CDUS, CEUS, and SMI relative to CTA was 27%, 100%, and 100%, respectively. Specificity was 93%, 93%, and 93%, respectively. Accuracy was 60%, 97%, and 97%, respectively. There were no differences between SMI and CEUS in terms of sensitivity, specificity, or accuracy (100%, 93%, and 97%). We do not observe statistically significant differences between CTA, CEUS, and SMI concerning endoleak identification ability. The weakest method in endoleak identification was CDUS. CONCLUSIONS: The analysis showed that SMI is effective, repeatable, and comparable with the CEUS modality in identification endoleaks after EVAR; it may be considered as a potential tool to monitor patients after EVAR implantation, especially those with renal insufficiency or with an allergy to any contrast media.

Comparison of Superb Micro-Vascular Ultrasound Imaging (SMI) and Contrast-Enhanced Ultrasound (CEUS) for Detection of Endoleaks After Endovascular Aneurysm Repair (EVAR).

BACKGROUND: High-resolution contrast-enhanced ultrasound is one of methods used in the detection and characterization of endoleaks, which is a frequent complication after EVAR. A new technology provided by Toshiba's AplioTM 500 ultrasound system, called Superb Micro-Vascular Imaging (SMI), is dedicated specifically to imaging very low flow states and appears to be a promising new method for detection of endoleaks. CASE REPORT: After endovascular treatment, a 68-year-old patient who had stent-graft implantation underwent clinical examinations, including contrast-enhanced ultrasound (CEUS), superb micro-vascular imaging (SMI), and computed tomographic angiography (CTA), revealing additional information about abnormal blood flow localized in the periphery of the sack of the left common iliac artery aneurysm. By using CEUS and SMI, the endoleak was clearly visible. CONCLUSIONS: This case report illustrates the potential clinical value of this advanced Doppler technology (SMI) and how it could influence clinical management.

Superior mesenteric artery dissection as a complication of an endovascular attempt to treat aneurysms of the pancreaticoduodenal arteries.

A case of iatrogenic dissection of the superior mesenteric artery (SMA) in a 42-year old woman during an attempt of endovascular treatment of aneurysms of the pancreaticoduodenal arteries coexisting with a stenosis of the coeliac trunk is presented. The dissection occurred most probably during insertion of an introducer sheath into the SMA. The patient at that moment reported a short-lasting abdominal pain and after that remained asymptomatic. Due to technical difficulties, the attempt of endovascular management of pancreaticoduodenal aneurysms was abandoned. The completion angiography revealed the occlusion of the SMA. The patient underwent an emergency laparotomy; pancreaticoduodenal aneurysms were excised and SMA dissection was repaired with endarterectomy and a patch closure. Postoperative recovery was uneventful and the patient remained asymptomatic during a 30-month follow-up. The case underscores the importance of completion angiography after endovascular interventions in the SMA since the early period of its occlusion may be asymptomatic.