Pulsatile wall motion and blood pressure in aneurysms with open and thrombosed endoleaks - comparison of a wall track system and M-mode ultrasound scanning: An in vitro and animal study
Gwh. Schurink et al., Pulsatile wall motion and blood pressure in aneurysms with open and thrombosed endoleaks - comparison of a wall track system and M-mode ultrasound scanning: An in vitro and animal study, J VASC SURG, 32(4), 2000, pp. 795-803
Citations number
23
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: Pulsatile wall motion has been suggested as a means by which to
evaluate abdominal aortic aneurysms after exclusion from the circulation to
determine whether the treatment has been effective. The objective of this
study was to investigate the relations between pulsatile wall motion and bo
th the mean and pulse pressures within the aneurysmal sac for both patent a
nd thrombosed endoleaks. furthermore, we compared the measurements of pulsa
tile wall motion by means of M-mode ultrasound scanning and a wall track sy
stem to determine the most reliable technique. Methods: First, interobserve
r and intraobserver variability of M-mode ultrasound scan measurements was
determined at different pressure levels in a cow iliac artery placed in an
in vitro circulation. M-mode ultrasound scanning and a wall track system we
re compared in the same model. Second, in an animal experiment, an aneurysm
and endoleak model with both patent and thrombosed endoleaks was created.
Systemic and aneurysmal mean and pulse pressures were recorded synchronical
ly with pulsatile wall motion by means of hi-mode ultrasound scanning and a
wall track system. Results: The intraobserver and interobserver variabilit
y values for M-mode ultrasound scan measurement in vitro were 0.11 mm (SD =
0.10 mm) and 0.15 mm (SD = 0.13 mm), respectively. In the animal study, a
significant difference existed with respect to the level of pulse pressure
within the aneurysmal sac between the group with pulsatile wall motion and
the group without such motion (P < .0001). The presence of pulsatile wall m
otion was not correlated with the level of aneurysmal mean pressure. The le
vel of pulsatile wall motion determined by means of M-mode ultrasound scann
ing correlated well with the level determined by means of the wall track sy
stem (r = 0.74; P = .01). For the level of pulsatile wall motion determined
by means of M-mode ultrasound scanning, a significant difference between p
atent and thrombosed endoleaks existed (P = .04). For detecting endoleaks,
the sensitivity and specificity of pulsatile wall motion as determined by m
eans of the wall track system were 52% and 100%, respectively, and the sens
itivity and specificity of pulsatile wall motion as determined by means of
M-mode ultrasound scanning were 64% and 67%, respectively. For the detectio
n of pulse pressure in the aneurysmal sac, the sensitivity and specificity
of pulsatile wall motion as determined by means of the wall track system we
re 76% and 100%, respectively, and the sensitivity and specificity of pulsa
tile wall motion as determined by means of M-mode ultrasound scanning were
90% and 71%, respectively. Conclusions: We found that pulsatile wall motion
is correlated with aneurysmal pulse pressure but not with the mean level o
f pressure inside the aneurysm. Although measurements of pulsatile wall mot
ion are of great theoretic value when groups of patients who have undergone
endovascular aneurysm repair are being compared, this method appears to be
unreliable in a clinical setting with respect to determining whether the a
neurysmal sac is still pressurized in individual patients.