Duplex Ultrasound will Reduce Costs of EVAR Surveillance but the Addition of Microbubble Contrast will Improve this Further
We were delighted to read the study of 145 patients in Dublin over seven years which compared CT and duplex ultrasound scan surveillance for EVAR.
1
In our unit we have adopted a similar first line surveillance programme using duplex ultrasound and abdominal x-ray like yourselves. However, in addition, we have also employed the use of contrast-enhanced ultrasound using microbubble contrast in a subset of patients where endoleaks require delineation or type definition as well as troubleshooting in cases where we know there is sac size expansion in without endoleak on CT. We have found contrast ultrasound particularly helpful as have numerous groups in the literature for these selected patient groups.2
, 3
, - Carrafiello G.
- Lagana D.
- Recaldini C.
- Mangini M.
- Bertolotti E.
- Caronno R.
- et al.
Comparison of contrast-enhanced ultrasound and computed tomography in classifying endoleaks after endovascular treatment of abdominal aorta aneurysms: preliminary experience.
Cardiovasc Intervent Radiol. 2006; 29: 969-974
4
, 5
The additional cost for adopting contrast-enhanced ultrasound scan is minimal when compared with the price of traditionally performed CT surveillance programmes, which were traditionally performed.We would like to ask the authors if they have used any microbubble contrast for their surveillance? and if not why not? The use of contrast-enhanced ultrasound would reduce the proportion of additional scans required due to bowel gas or body habitus. We have found the contrast microbubble reduces this uncertainty. One other feature of your study which we felt we would like explained were the actual costings and total periods of clinical evaluation following endovascular stenting? We regularly see our patients at six month or yearly intervals to see if they are improving symptomatically and also to assess procedural recovery. We have also found that if the patient is symptomatic, then this correlates extremely well with unsatisfactory results from stent-grafting. However, we are delighted with the results you present and are in agreement in championing duplex ultrasound as the primary surveillance tool for patients who have undergone endovascular aneurysm repair, but also recommend the addition of contrast-enhanced ultrasound scan in selective cases.
References
- Use of colour duplex ultrasound as a first line surveillance to following EVAR is associated with a reduction in cost without compromising accuracy.Eur J Vasc Endovasc Surg. 2012 Aug; 44 (Epub 2012 Jun 19): 145-150
- Is it time to eliminate CT after EVAR as routine follow-up?.J Cardiovasc Surg (Torino). 2011; 52: 193-198
- Comparison of contrast-enhanced ultrasound and computed tomography in classifying endoleaks after endovascular treatment of abdominal aorta aneurysms: preliminary experience.Cardiovasc Intervent Radiol. 2006; 29: 969-974
- Abdominal aortic aneurysm: contrast-enhanced US for missed endoleaks after endoluminal repair.Radiology. 2004; 233: 217-225
- Efficacy of ultrasound scan contrast agents in the noninvasive follow-up of aortic stent grafts.J Vasc Surg. 2003; 37: 381-385
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Published online: September 27, 2012
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© 2012 European Society for Vascular Surgery. Published by Elsevier Inc.
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- Use of Colour Duplex Ultrasound as a First Line Surveillance Tool Following EVAR is Associated with a Reduction in Cost Without Compromising AccuracyEuropean Journal of Vascular and Endovascular SurgeryVol. 44Issue 2
- PreviewCT scanning remains the postoperative surveillance imaging modality of choice following EVAR. Concerns regarding cost, exposure to ionising radiation and intravenous contrast have led to a search for a less expensive, equally efficacious and safer method of monitoring EVAR patients after endograft deployment. This study evaluated the cost saving obtained if CDUS was employed as a first line surveillance tool following EVAR, as well as comparing the two entities in terms of efficacy.
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