Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair

A 74-year-old man treated with endovascular aneurysm repair (6-month follow-up). a, A large endoleak was correctly detected on color duplex ultrasound imaging and (b) contrast-enhanced ultrasound images, and (c) was confirmed by standard of reference.

An 82-year-old man treated with endovascular aneurysm repair at 1-month follow-up. a, The baseline color duplex ultrasound image did not demonstrate any color duplex signal beyond the graft, with a consequent negative diagnosis for endoleak. b, The contrast-enhanced ultrasound image showed a small endoleak (arrows) at 150 seconds after contrast injection which was regarded as a low-flow leak. c and d, Standard of reference confirmed the presence of a small endoleak on the posterolateral side of the aneurysm, detected only on delayed phase axial CT image (low-flow leak) (arrows in panel d).

A 78-year-old woman treated with endovascular aneurysm repair at the 12-month follow-up. a, A contrast-enhanced ultrasound image shows a high attenuation area outside the graft (arrows) but within the aneurysm sac, and an endoleak was diagnosed. b, However, no endoleak was detected on axial arterial and (c) delayed-phase computed tomography images. d, An accurate evaluation of the baseline color duplex ultrasound image allows the recognition of a high attenuation of the thrombus outside the stent graft lumen (arrows) excluding the previous false-positive endoleak.

Qualitative evaluation of endoprosthesis visualization scores for color duplex (gray bars), and contrast-enhanced ultrasound imaging (CEUS) with 1.2 mL (diagonal-patterned bars) and 2.4 mL (dark gray). An, Anastomosis; Br, branch; Prox, proximal.

A 71-year-old man treated with endovascular aneurysm repair at the 1-month follow-up. A large endoleak located in a posterolateral position was shown on the (a, c) three-dimensional and (b) axial computed tomography images, associated with (c) opacification of a lumbar artery, classified as a type II endoleak. However, the leak was also strictly adjacent to the prosthesis, with a consequent possible diagnosis of a concomitant type III endoleak. A classification of the endoleak was not clearly performed on the basis of the computed tomography images. d, An evaluation of dynamic contrast-enhanced ultrasound images demonstrated the back-filling of the excluded aneurysmal sac via lumbar artery, excluding a concomitant type III endoleak, as confirmed by digital subtraction angiography (e-g, arrows in f and asterisk in g).