Author/Authors :
Mascoli, Chiara University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Faggioli, Gianluca University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Gallitto, Enrico University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Vento, Vincenzo University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Indelicato, Giuseppe University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Pini, Rodolfo University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Vacirca, Andrea University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Stella, Andrea University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy , Gargiulo, Mauro University of Bologna - Policlinico S. Orsola-Malpighi - Bologna, Italy
Abstract :
Iodinated contrast media completion angiography (ICM-A) may underestimate the presence of type II endoleak
(ELII) after endovascular aortic repair (EVAR), particularly if they are at low flow. Contrast-enhanced ultrasound (CEUS) has been
proposed as the gold standard in ELII detection during EVAR follow-up. Intraprocedural carbon dioxide (CO2) angiography has
been shown to be useful in this setting; however no comparative studies including these three techniques are currently available. Our
aim was to investigate the accuracy of a new automated CO2 angiographic (CO2-A) system in the detection of ELII, by comparing
it with ICM-A and CEUS. Methods. A series of consecutive patients undergoing EVAR for abdominal aortic aneurysm (AAA)
were enrolled and submitted to ICM-A and CO2-A during the procedure. The iodinated contrast media were delivered through an
automatic injector connected to a pigtail catheter in the suprarenal aorta. CO2 was delivered through a recently available automatic
injector connected to a 10 F sheath positioned in the external iliac artery. All patients were blindly evaluated by CEUS within
postoperative day 1. The ICM-A and CO2-A ability to detect ELII was compared with that of CEUS through Cohen’s concordance
Index (K). Results. Twenty-one patients were enrolled in the study. One (5%), seven (33%), and four (19%) ELII were detected by
ICM-A, CO2-A, and CEUS, respectively. The only ELII detected by ICM-A was also detected by CO2-A and CEUS. Tree cases
of ELII detected by CO2-A were not detected by CEUS. All ELII detected by CEUS were visualized by CO2-A. CEUS and ICM-A
showed a poor agreement (Cohen’s K: 0.35) while CEUS and CO2-A showed a substantial agreement (Cohen’s K: 0.65) for ELII
detection. Conclusion. CO2-A is safe and efective method for ELII detection in EVAR, with a signifcantly higher agreement with
CEUS if compared with ICM-A. Tis trial is registered with 155/2015/U/Oss.
Keywords :
Ultrasound , Dioxide , EVAR , ICM
