Duplex Ultrasound Versus Computed Tomography for Follow Up of Complications after Evar with Nellix Endograft: First Clinical Experience

Summary Introduction.Contrast-enhanced computed tomography (CT) has become the ‘gold-standard’ imaging modality for surveillance following EVAR (2, 20). However repeated CT is related to increased cost, risk of contrast nephropathy and radiation exposure. Duplex ultrasound (DUS) is a less invasive but considered less accurate method than CT. Aim of the study. The aim of this study was to determine the diagnostic accuracy of both imaging modalities for detection of complications in post-EVAR patients where the new generation sac-sealing endograft was used and to compare cost-effectiveness and sensitivity of both imaging modalities. Methods. Analysis of 23 post-EVAR patients with implantation of new generation sac-sealing endograft device (Nellix®, Endologix, USA) was performed, making a comparison of CT and DUS. Contrast-enhanced computed tomography was taken as the ‘goldstandard’ investigation. DUS was compared to CT for analysis of sensitivity, post-imaging complications and cost-effectiveness. Statistical analysis of data was performed using v19.0 SPSS software (IBM). Results. Analysis of CT and DUS studies compared in 23 patients. Both imaging modalities can detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between two imaging techniques is substantial. Our results demonstrate that DUS surveillance during follow-up after EVAR where new generation sac-sealing endograft is used can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and eliminating CT related radiation and nephrotoxicity. Conclusion. CT and DUS imaging can both detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between the two imaging techniques is substantial. Our results demonstrate that in post-EVAR patients where new-generation sac-sealing endograft was deployed DUS surveillance performed by experienced radiologist can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and avoiding CT-related complications.