Cilj: Kompjutorizirana tomografska angiografija (CTA) zlatni je standard za otkrivanje endoleaka nakon endovaskularnog liječenja aorte (EVAR). Cilj je ovog rada utvrditi može li kontrastni ultrazvuk ...(CEUS) zamijeniti CTA u dijagnostici endoleaka nakon EVAR-a. Materijali i metode: Pregled literature na engleskom jeziku proveden je u bazama podataka: PubMed/MEDLINE, ScienceDirect, Google Scholar. Ključne riječi bile su: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studije koje su odgovarale kriterijima uključivanja recenzirane su u cijelosti te je odabrano 39 studija. Rezultati: Pacijenti su u analiziranim studijama najvećim dijelom bili muškarci (86 %). Medijan dobi iznosio je 74 godine. Endoleak nakon EVAR-a promatran je u infrarenalnih (79 %), jukstarenalnih (17 %) i suprarenalnih aneurizama (4 %). Stopa endoleaka kretala se između 3 i 52 %. Najčešći endoleak bio je po tipu II te se u 15 % slučajeva javljao unutar prvih šest mjeseci, odnosno u manje od 10 % slučajeva unutar dvije godine nakon EVAR-a. Za sve tipove endoleaka CEUS je pokazao uravnoteženu osjetljivost, specifičnost i područje ispod krivulje od 94 %, 88 % i 96 %. U odnosu na CTA, CEUS ima veću osjetljivost (94/83 %), ali lošiju specifičnost (94,8/99 %). Specifično za tip II endoleaka, CEUS je imao veću stopu detekcije (36,88/20,88 %). Visoka osjetljivost (97 %) i specifičnost (100 %) obilježje su CEUS-a u prikazu endoleaka tipa I i III, bez prednosti u odnosu na CTA. Zaključci: CEUS je slikovna metoda ravnopravna CTA u probiru pacijenata za endoleak nakon EVAR-a. CEUS ne može u potpunosti nadomjestiti CTA, no sigurna je i efikasna alternativa za korištenje u pacijenata bez CTA komplikacija nakon jednogodišnjeg kontrolnog intervala.
Aim: Computed tomography angiography (CTA) is the mainstay in endoleak detection after endovascular aneurysm repair (EVAR). The objective of this review is to determine if contrast enhanced ultrasound (CEUS) is able to replace CTA in monitoring endoleaks in patients after EVAR. Materials and methods: The literature search of Englishlanguage articles was conducted in PubMed/MEDLINE, ScienceDirect, Google Scholar. The used keywords included: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studies appearing to meet inclusion criteria were reviewed in full and 39 studies were included. Results: In analysed studies, patients were predominantly men (86%) and median age was 74 years. Endoleak after EVAR was followed in infrarenal (79%), juxtarenal (17%) and suprarenal aneurysms (4%). Endoleak detection rate was 3-52%. Type II endoleaks were the most frequently encountered – in 15% of cases during the first six months and in less than 10% of cases during the first two years after EVAR. In diagnosing all endoleaks, CEUS demonstrated sensitivity, specificity, and AUC of 94%, 88%, 96%, respectively. Compared to CTA, CEUS possesses higher sensitivity (94/83%), but lesser specificity (94.8/99%). Particularly in type II endoleak evaluation, CEUS provided higher detection rates (36.88/20.88%). Regarding type I and type III endoleaks, CEUS demonstrated high sensitivity (97%) and specificity (100%), but without superiority over CTA. Conclusions: CEUS is an imaging technique equivalent to CTA in screening for post-EVAR endoleaks. CTA cannot be entirely replaced by CEUS; however, it is safe and effective alternative method to use after one year of negative CTA exams.
