Follow-up evaluation of endoluminally treated abdominal aortic aneurysms with duplex ultrasonography: Validation with computed tomography

Objective: A growing number of patients with abdominal aortic aneurysms are currently being offered endoluminal treatment. However, the incidence of e ndoleaks, stenosis, and thrombosis is around 25% to 30%. As a result, a str ict postprocedure imaging surveillance protocol is necessary. The purpose o f this study was to compare duplex ultrasonography (DU) and computed tomogr aphy (CT) for the follow-up of endoluminally treated aortic aneurysms. Methods: A total of 89 patients were followed up with serial CT and DU at 1 , 3, 6, 12, and 24 months after endoluminal treatment. Special attention wa s directed toward the presence of endoleaks and aneurysm diameter evolution . Preoperative CT and DU were also reviewed to assess aneurysm diameter cor relation. Results: With DU, 14 type I and 21 type II endoleaks were identified. In on e case the DU did not visualize a type II endoleak present on CT, and CT di d not confirm three type II leaks identified with DU. There was only one fa lse-positive for type I endoleak with DU. The sensitivity of DU was 96% wit h a specificity of 94%, when compared with CT. A linear regression analysis of the diameters obtained with DU and CT revealed a good correlation. Howe ver, variability was high, indicating poor agreement. Regarding diameter ev olution, the range was identical in 45%, and the trend was similar in 73%. However, in 9% of the cases, DU showed a decrease in diameter, whereas CT s howed a significant increase. Conclusion: DU is an accurate tool for the diagnosis of endoleaks, but is l ess valuable for diameter measurements, when compared with CT. Currently, D U is a useful tool, but CT remains a key part of the postoperative evaluati on after endoluminal treatment of abdominal aortic aneurysms. At institutio ns where DU is used for follow-up, researchers should perform quality contr ol studies to avoid potentially significant errors.