L'ecografia con mezzo di contrasto nella diagnosi degli endoleak nel paziente sottoposto ad embolizzazione preventiva della sacca aneurismatica

Introduction Persistent type II endoleaks (ELIIp) may occur in up to 10% of patients underwent endovascular aneurysm repair (EVAR) and may lead to aneurysm progression and rupture. Intraoperative abdominal aortic aneurysm repair (AAA)- sac embolization in selected high-risk patients can be effective to reduce their incidence; however the follow up of these patients can be compromised by the artefacts of embolisation materials. Aim of our study was compare contrast enhanced ultrasound (CEUS) with computer tomography angiography (CTA) and color-Doppler ultrasound (CDU) in the detection of ELIIp. Methods Between 2012 and 2013 all patients with morphological features with high risk for ELIIp [more than six efferent patent vessels -EPV- and/ or VR (thrombus volume ratio) inferior to 40% analysed in CTA], underwent EVAR with adjunctive intra-procedural AAA-sac coil embolization; they have been evaluated at 12 months with Color-Doppler Ultrasound, Contrast Enhanced Ultrasound (CEUS) and Computer Tomography Angiography (CTA). Results Moderate concordance was found between CEUS and CDU (k ? 0.475, p < 0.030), confirmed by Mc Nemar test p ? 1.000; whereas optimal concordance between CEUS and CTA was detected, Mc Nemar test p ? 1.000. Analysis of haemodynamical features (both inflow and outflow) doesn't show a significant impact of leaks'kinetic on CTA sensitivity (p ? 0.127, p ? 1.000 respectively). Conclusions CEUS in patients that underwent sac-embolization during EVAR showed more sensitivity than CDU and CTA on the detection of ELIIp, and is not affected by artefacts of coils.