Feasibility of contrast-enhanced ultrasound in the detection and classification of endoleaks after endovascular aneurysm repair.

ABSTRACT

Background: Endoleaks are common complications after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA)/digital subtraction angiography (DSA) is considered the gold standard for evaluating contrast-enhanced ultrasound (CEUS) accuracy in the detection and classification of endoleaks. In recent years, CEUS has been widely used in this field. This study aimed to analyze the accuracy of CEUS in the detection and classification of endoleaks after EVAR. Methods: The data of 98 patients who underwent abdominal aorta CEUS from November 2017 to September 2023 in the ultrasound (US) department of Beijing Hospital were retrospectively analyzed. All the patients underwent EVAR of AAA before CEUS and CTA/DSA, and had complete clinical data. The CEUS and CTA/DSA results were compared to detect endoleaks and categorize the specific types of endoleaks. Results: Among the 98 patients, 74 were male and 24 were female. The patients had an average age of 74.8±9.8 years (range, 43-90 years). Among the 98 patients, 37 (37.8%) endoleaks were detected by CEUS, of which 8 were type Ia, 2 were type Ib, 15 were type II, 7 were type III, 2 were type IV, 2 were type Ia combined with type III, and 1 was type II combined with type III. In addition, among these 98 patients, 39 (39.8%) endoleaks were detected by CTA/DSA, of which 8 were type Ia, 3 were type Ib, 18 were type II, 6 were type III, 2 were type Ia combined with type III, 1 was type II combined with type III, and 1 was type Ib combined with type II. The sensitivity and specificity of CEUS in the detection of endoleaks were 92.3% and 98.3%, respectively. CEUS and CTA/DSA had similar diagnostic efficacy and good consistency in the detection and classification of endoleaks (Kappa value 0.914, P<0.01). Conclusions: CEUS has high sensitivity and specificity in the detection and classification of endoleaks following EVAR, and its diagnostic efficacy is similar to that of CTA/DSA. In addition, US is safe, non-invasive and repeatable, and thus is worthy of extensive clinical application.