Patients and Methods
Between January 2018 and March 2020, we organized a follow-up protocol
between Department of Radiology and Department of Cardiovascular
Surgery. Consecutive 84 patients who experienced elective and standard
EVAR procedure for infrarenal abdominal aortic aneurysm, were evaluated
in the outpatient clinic. The mean age of the patients was 68.5±7.8
years (61-89 years). Patient demographics are given in table 1. Hybrid
operations, complex EVAR procedures (chimney, snorkel) and emergency
cases were excluded. Two operators were performing all the CDUS from the
Radiology Department. CDUS operators were blind of any CTA reports as
CDUS was carried out first. The time between two modalities was 7 days
in average. The reporting protocol was organized as the detection of an
endoleak and sac measurements. Caliper placements for measurement of
aortic diameter were put into a consensus as outer to outer manner. All
reports were recorded to patient’s charts.
Commercially available devices were used during the study, including
Medtronic Endurant II, Endologix AFX, Gore Excluder, Jotec and Lifetech
Ankura. Endoskeletons were nitinol except Endologix AFX (cobalt
chromium) and graft material was Dacron or PTFE.
This study follows the Declaration of Helsinki and ethical approval was
granted by the local institutional ethical board. In addition, informed
consent was obtained from all the patients.
CDUS. All CDUS was performed by using a GE Logiq S7 Expert R3
(General Electric Company, Millwakuee, WI) equipped with C1-6 Mhz
curvilinear broadband transducer probe. Aorta was scanned from the
diaphragm to the iliac vessels by transverse and longitudinal planes,
the aortic diameter was measured outer to outer manner always. Multiple
transverse and anteroposterior measurements were obtained, and maximum
measurements were recorded. All patients were asked to fast up to 6-8
hours. All patients were scanned in the supine position in a dark
out-patient clinic room according to the organized protocol. The
endograft and the aneurysm sac were assessed using B-mode, color flow
and spectral Doppler to rule out any endoleak. Doppler scan with color
flow was confirmed with spectral analysis and mapping of blood flow
pattern. Contrast was not used in any patient.
CTA. The CTA protocol consisted of a set of an arterial scan
phase followed by a single venous scan phase. All of the CT angiograms
were obtained with a 512 - slice CT scanner (Revolution CT, GE
Healthcare, Waukesha, Wisconsin, US). Patients were examined in the
supine position. After localizer scans were obtained and 90 mL of
nonionic iodinated contrast material (Iohexol, Omnipaque 350 mg of
iodine per milliliter; GE Healthcare) was injected at a flow rate of 4
mL/sec through an 18-gauge antecubital intravenous line, the CT
angiography series was started with bolus-tracking measurement in the
abdominal aorta at a threshold of 170 HU. The arterial phase of the
series was followed by venous phase scanning that covered the entire
abdominal aorta, with a delay of 80 seconds after completion of the
first scan