IP009. Intraoperative Contrast-Enhanced Ultrasound for Early Diagnosis and Treatment of Endoleaks During Endovascular Abdominal Aortic Aneurysm Repair∗

Abstract

The objective of this study was to evaluate the feasibility of intraoperative contrast-enhanced ultrasound (CEUS) to detect and to treat endoleaks (EL) during endovascular aneurysm repair (EVAR). Patients undergoing elective EVAR from January to December 2017 were consecutively enrolled. After endograft deployment, two completion angiography studies (2CAs) with orthogonal C-arm angulation (anteroposterior and 90-degree left anterior oblique) were routinely performed. Intraoperative CEUS was performed in sterile conditions on the surgical field before guidewire removal. Presence and type of EL at the 2CAs and CEUS were evaluated and prospectively collected. CEUS was performed by a vascular surgeon blinded to the findings of the 2CAs. The primary end point was the agreement between the 2CAs and CEUS for detection of any EL and type II EL (Cohen κ). The secondary end point was evaluation of number and type of intraoperative adjunctive procedures performed as a result of CEUS findings. Forty-four patients were enrolled (mean age, 77 ± 6 years; male, 91%). The 2CAs revealed 9 ELs (21%; type IA, 1; type II, 8; Table), and CEUS revealed 18 ELs (41%; type IA, 2; type II, 16; Fig). The 2CAs and CEUS showed the same findings in 28 cases (64%; no EL, 23; type II EL, 5). CEUS detected 12 ELs unidentified by the 2CAs (27%; type IA, 2; type II, 10). The 2CAs discovered three ELs unseen at CEUS (7%; type II, three). For EL and type II EL detection, Cohen κ was 0.236 and 0.175, respectively. On the basis of CEUS findings, adjunctive intraoperative procedures were performed in five patients (11%): Palmaz stent was deployed for a type IA EL in one case; sac embolization with coils was performed under CEUS control in four cases according to the preoperatively planned procedure. Intraoperative CEUS during EVAR detected a higher number of ELs than the 2CAs and allowed more precise identification of EL type. CEUS is a useful tool in intraoperative sac embolization for type II EL.TableEndoleaks (ELs) detected with two completion angiography studies (2CAs) and contrast-enhanced ultrasound (CEUS) in 44 patientsCEUSTotal+−2CAs+639−122335Total182644 Open table in a new tab