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Demystifying Endovascular Treatment of Abdominal Aortic Aneurysms: A Study by CT Angiography at a Tertiary Hospital

Md. Khizer Razak, Surbhi Gupta and Meena GL*

Aims & Objectives: The aim of this study is to compare the results of Doppler ultrasound with enhancer (EDP) versus CT angiography in the follow-up of patients with AAA(Abdominal-aortic-aneurysms) treated with EVAR(endovascular treatment), compare our results with the published literature and be able to validate the EDP in our hospital for the follow-up of AAAs treated by EVAR.
Material & Methods: Of all patients with AAA treated by EVAR in our P.B.M hospital and to whom controls are being performed, 22 patients were randomly selected. The informed consent of the patients was obtained both for the performance of the control CT angiography and for the realization of the EDP. All of them underwent first a CT angiography and then the EDP. Two radiologists, one with 21 years of experience in EDP and the other radiologist with 3 years of experience in angio-CT, independently analyzed the results of the tests without knowing the results of the other test.
Results: The mean diameter of the residual aneurysmal sac measured by EDP was 64.49 ± 15.12 mm (41.5- 104) with a median of 63 mm and measured by angio-CT showed an average diameter of 59.41 ± 17.54 mm (30- 108) with a median of 59 mm. Angio-CT identified a leak in 13.63% of the cases (n=3). The EDP demonstrated leakage in 31.82% of the cases (n=7), all type II; in 85.72% of cases (n=6) they corresponded to hyperdynamic type II leaks (before 100 seconds) and 14.28% of cases (n=1) corresponded to hypodynamic type II leaks (after 100 seconds). The values of sensitivity, specificity, positive and negative predictive value of the EDP were: sensitivity 100%, specificity 79%, positive predictive value 43% and negative predictive value 100%.
Conclusion: The EDP is a technique that does not irradiate, it can be used in patients in whom the use of iodinated contaste is contraindicated. It is more specific than angio-CT for detecting low-flow leaks, being able to consider it as the first modality of imaging in the follow-up of patients after EVAR. The EDP allows an economic saving since the angio-CT or angio-MR are more expensive than the realization of an EDP. Our results are in agreement with those published by other authors, but we need a wider series to give greater statistical strength to our results. There is a perfect correlation between the two techniques when assessing the diameter of the residual aneurysmal sac.