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Ultrasound Surveillance after Endovascular Abdominal Aortic Aneurysm Repair

Authors:
Yisha Tong at Austin Health
Yisha Tong
Gary Fell
Gary Fell
Gary Fell
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Abstract

Ultrasound Surveillance after Endovascular Abdominal Aortic Aneurysm Repair - Presented at 2011 Asian Chapter Congress of the International Union of Angiology (Beijing, China, October 2011)
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Duplex Ultrasound Surveillance
after Endovascular Abdominal
Aortic Aneurysm Repair
Yisha Tong and Gary Fell
Austin Hospital, Melbourne, Australia
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Abdominal Aortic Aneurysm (AAA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Abdominal Aortic Aneurysm (AAA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
80% - 90%: Mortality
AAA – Open Repair
Asian Chapter Congress of the IUA, 20 - 22 October 2011
AAA – Endovascular Repair
(EVAR)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
AAA Open Repair vs EVAR in Australia
Asian Chapter Congress of the IUA, 20 - 22 October 2011
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19941995199619971998199920002001200220032004200520062007200820092010
Open repair
EVAR
Medicare Data
Surveillance after EVAR - Why
Device related endoleak
Migration → Type I endoleak
Disconnection → Type III endoleak
Material fatigue → Type III endoleak
Procedure related endoleak
Retrograde flow from aortic branches →
Type II endoleak
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Surveillance after EVAR - How
Abdominal plain X-ray – Assess
position and integrity of device
metallic support system
CTA – Gold standard for endoleak
detection
Duplex ultrasound – Safer, effective
and less expensive alternative to CTA,
with limitations
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Issues with CTA Surveillance after EVAR
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Cumulative contrast load
Deterioration in renal function
Cumulative radiation
Increased carcinogenic risk
Cost
5 yrs surveillance increase total cost of
EVAR by 50% - 1/3 of this cost is for
imaging
What Can Duplex Ultrasound Offer?
Assess stent graft patency
Graft body
Graft limbs
Detect endoleak
Direct: Presence of blood flow in the
aneurysm sac
Indirect: Increasing aneurysm sac size
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Stent Graft Patency – Graft Body
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Stent Graft Patency – Graft Body
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Stent Graft Patency – Graft Limbs
Asian Chapter Congress of the IUA, 20 - 22 October 2011
One of the Graft Limbs thrombosis
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Endoleak
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Type I Endoleak
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Type II Endoleak (LA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Type II Endoleak (LA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Type II Endoleak (LA-IMA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Type II Endoleak (LA-IMA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Type II Endoleak (LA-IMA)
Asian Chapter Congress of the IUA, 20 - 22 October 2011
AAA Sac Size Measurement
Asian Chapter Congress of the IUA, 20 - 22 October 2011
*
*
*
Shrinking AAA Sac
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Shrinking AAA Sac
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Shrinking AAA Sac
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Limitations of Duplex Ultrasound
Patient dependent
Body habitus
Excessive bowel gas
Operator dependent
Experience
Technical issues: Mirror artefact,
Flash artefact
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Bowel Gas
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Excessive Bowel Gas
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Mirror Artefact
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Mirror Artefact
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Flash Artefact
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Austin Hospital EVAR Surveillance
Prior to discharge: Abdomen plain X-ray
1 month: CTA and duplex ultrasound
3 months: Duplex ultrasound*
6 month: Duplex ultrasound*
12 months: Abdomen plain X-ray and duplex
ultrasound*
Yearly: Duplex ultrasound*
* CTA if abnormality detected by duplex ultrasound or
abdomen plain X-ray
Asian Chapter Congress of the IUA, 20 - 22 October 2011
SVS EVAR Surveillance Guidelines
1 month: CTA
6 month: CTA (only if abnormality detected
at CTA one month post EVAR)
12 months: CTA
Yearly: Duplex ultrasound
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Summary
Duplex ultrasound is a useful tool for
surveillance after EVAR
Duplex ultrasound can significantly
reduce the number of CTAs required and
therefore reduce cost and potential risks
associated with CTA
Asian Chapter Congress of the IUA, 20 - 22 October 2011
Asian Chapter Congress of the IUA, 20 - 22 October 2011
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