Welche Nachkontrolle ist bei endovaskulärer Versorgung von abdominellen Aortenaneurysmen empfehlenswert?

Zusammenfassung

Die Mehrphasen-CT-Angiografie (MS-CTA) wird als Goldstandard in der Nachkontrolle von endovaskulär versorgten abdominellen Aortenaneurysmen betrachtet. Bei den häufig multimorbiden Patienten ist jedoch die Anwendung von jodhaltigem und potenziell nephrotoxischem Kontrastmittel eingeschränkt. Die farbkodierte Duplexsonografie (FKDS) und insbesondere die Kontrastmittel-verstärkte Sonografie (CEUS) ist eine nicht invasive Methode, die eine kostengünstige Beurteilung von Endoleaks ermöglicht. Weiterhin können die Prothesenschenkel sowie Viszeral- und Nierenarterien funktionell im Hinblick auf mögliche Stenosierungen untersucht werden. Viele verschiedene Studien zeigen die Sonografie der CTA zumindest gleichwertig in der Beurteilung von Endoleaks. Bei Patienten mit eingeschränkter Nierenfunktion ist die CEUS in Kombination mit der konventionellen Röntgenuntersuchung zur Kontrolle des Endoprothesensitzes und von Materialbrüchen geeignet.

Abstract

In the past, multislice computed tomography angiography (CTA) with arterial and venous phase was recommended as the gold standard in follow-up after endovascular abdominal aneurysm repair (EVAR). Iodine-containing contrast agents and frequent radiation exposure are limitations for use in elderly patients with chronic renal insufficiency. Colour-coded Doppler sonography (CCDS) and, especially, contrast-enhanced ultrasound (CEUS) are non-invasive methods that are time and cost effective. Both provide a reliable alternative to CTA in surveillance after EVAR. CEUS seems to be superior in characterisation of the type of endoleaks and can be established in order to reduce iodine-containing contrast agent and radiation exposure in follow-up. In contrast to CTA scans, CEUS can be offered to patients with chronic renal insufficiency and allows a dynamic examination and perfusion analysis (e. g., in fenestrated and branched stentgrafts). Routine combination with X-ray allows control of stentgraft material and location of the branches.

Schlüsselwörter

Aortenaneurysma - Kontrastmittelsonografie - Nachsorge - endovaskuläre Therapie - Endoleak

Key words

aortic aneuyrsm - contrast-enhanced ultrasound - follow-up - endovascular treatment - endoleak

Literatur

• 1 Chaikof E L, Brewster D C, Dalmann R L et al. The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines.  J Vasc Surg. 2009;  50 (4 Suppl) 52-49
• 2 Botsios S, Schmidt A, Klaeffling C et al. Endovascular treatment of abdominal aortic aneurysms in octogenarians.  Zentralbl Chir. 2009;  134 325-330
• 3 Brewster D C, Jones J E, Chung T K et al. Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade.  Ann Surg. 2006;  244 426-438
• 4 Collins J T, Boros M J, Combs K. Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography.  Ann Vasc Surg. 2007;  21 671-675
• 5 AbuRahma A F. Fate of endoleaks detected by CT angiography and missed by color duplex ultrasound in endovascular grafts for abdominal aortic aneurysms.  J Endovasc Ther. 2006;  13 490-495
• 6 Beeman B R, Doctor L M, Doerr K et al. Duplex ultrasound imaging alone is sufficient for midterm endovascular aneurysm repair surveillance: a cost analysis study and prospective comparison with computed tomography scan.  J Vasc Surg. 2009;  50 1019-1024
• 7 Chaer R A, Gushchin A, Rhee R et al. Duplex ultrasound as the sole long-term surveillance method post-endovascular aneurysm repair: a safe alternative for stable aneurysms.  J Vasc Surg. 2009;  49 845-849
• 8 Clevert D A, Horng A, Schick K et al. Kontrastmittelverstärkter Ultraschall im Follow-up nach endovaskulärer Stentversorgung eines infrarenalen Bauchaortenaneurysmas.  Radiologe. 2009;  49 1048-1057
• 9 Carrafiello G, Recaldini C, Laganà D et al. Endoleak detection and classification after endovascular treatment of abdominal aortic aneurysm: value of CEUS over CTA.  Abdom Imaging. 2008;  33 357-362
• 10 Giannoni M F, Fanelli F, Citone M et al. Contrast ultrasound imaging: the best method to detect type II endoleak during endovascular aneurysm repair follow-up.  Interact Cardiovasc Thorac Surg. 2007;  6 359-362
• 11 Greis C. Technology overview: SonoVue (Bracco, Milan).  Eur Radiol. 2004;  14 11-15
• 12 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008.  Ultraschall Med. 2008;  29 28-44
• 13 Henao E A, Hodge M D, Felkai D D et al. Contrast-enhanced Duplex surveillance after endovascular abdominal aortic aneurysm repair; improved efficacy using a continuous infusion technique.  J Vasc Surg. 2006;  43 259-264
• 14 Veith F J, Baum R A, Ohki T et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference.  J Vasc Surg. 2002;  35 1029-1035
• 15 Greenberg R K, Chuter T AM, Lawrence-Brown M et al. Analysis of renal function after aneurysm repair with a device using suprarenal fixation (Zenith AAA endovascular graft) in contrast to open surgical repair.  J Vasc Surg. 2004;  39 1219-1228
• 16 Bargellini I, Napoli V, Petruzzi P et al. Type II lumbar endoleaks: hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular aneurysm repair.  J Vasc Surg. 2004;  41 10-13
• 17 Jung E M, Rennert J, Fellner C et al. Detection and Characterization of Endoleaks Following Endovascular Treatment of Abdominal Aortic Aneurysms using Contrast Harmonic Imaging (CHI) with Quantitative Perfusion Analysis (TIC) Compared to CT Angiography (CTA).  Ultraschall Med. 2009;  [Epub ahead of print]
• 18 Parodi J C, Palmaz J C, Barone H D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.  Ann Vasc Surg. 1991;  5 491-499
• 19 Schermerhorn M L, O’Malley A J, Jhaveri A et al. Endovasular vs open repair of abdominal aortic aneurysms in the Medicare population.  N Engl J Med. 2008;  358 464-474
• 20 Hobo R, Buth J. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report.  J Vasc Surg. 2006;  43 896-902
• 21 Jones J E, Atkins M D, Brewster et al. Persistent Type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes.  J Vasc Surg. 2007;  46 1-8
• 22 Tsilimparis N, Laipple A, Yousefi S et al. Role of endovascular therapy for redo surgery in patients after aortoiliac aneurysm exclusion.  Zentralbl Chir. 2009;  134 331-337
• 23 Gelfand D V, White G H, Wilson S E. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm.  Ann Vasc Surg. 2006;  20 69-74
• 24 Rayt H S, Sandord R M, Salem M et al. Conservative Management of Type 2 Endoleaks is not Associated with Increased Risk of Aneurysm Rupture.  Eur J Vasc Endovasc Surg. 2009;  38 718-723
• 25 Schmieder G C, Stout C L, Stokes G K et al. Endoleak after endovascular aneurysm repair: duplex ultrasound imaging is better than computed tomography at determining the need for intervention.  J Vasc Surg. 2009;  50 1012-1017
• 26 Kranokpiraksa P, Kaufman J A. Follow-up of endovascular aneurysm repair: plain radiography, ultrasound, CT / CT angiography, MR imaging / MR angiography, or what?.  J Vasc Interv Radiol. 2008;  19 27-36
• 27 Sternbergh 3rd  W C, Greenberg R K, Chuter T A et al. Zenith Investigators. Redefining postoperative surveillance after endovascular aneurysm repair: recommendations based on 5-year follow-up in the US Zenith multicenter trial.  J Vasc Surg. 2008;  48 278-284
• 28 Sommer W H, Graser A, Becker C R et al. Image quality of virtual noncontrast images derived from dualenergy CT angiography after endovascular aneurysm repair.  J Vasc Interv Radiol. 2010;  21 315-321
• 29 Manning B J, O'Neill S M, Haider S N et al. Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.  J Vasc Surg. 2009;  49 60-65
• 30 Mirza T A, Karthikesalingam A, Jackson D et al. Duplex Ultrasound and Contrast-Enhanced Ultrasound Versus Computed Tomography for the Detection of Endoleak after EVAR: Systematic Review and Bivariate Meta-Analysis.  Eur J Vasc Endovasc Surg. 2010;  39 418-428
• 31 Sandford R M, Bown M J, Fishwick G et al. Duplex ultrasound scanning is reliable in the detection of endoleak following endovascular aneurysm repair.  Eur J Vasc Endovasc Surg. 2006;  32 537-541
• 32 Schuster H, Dünser E, Bergmayr W et al. Sonografie des abdominellen Aortenaneurysmas: Diagnose, Erkennen von Komplikationen und Nachkontrolle nach endovaskulärer Therapie.  Ultraschall in Med. 2009;  30 528-543
• 33 Iezzi R, Cotroneo A R, Basilico R et al. Endoleaks after endovascular repair of abdominal aortic aneurysm: value of CEUS.  Abdom Imaging. 2010;  35 106-114
• 34 Pfister K, Rennert J, Uller W et al. Contrast harmonic imaging ultrasound and perfusion imaging for surveillance after endovascular abdominal aneurysm repair regarding detection and characterization of suspected endoleaks.  Clin Hemorheol Microcirc. 2009;  43 119-128
• 35 Go M R, Barbato J E, Rhee R Y et al. What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients?.  J Vasc Surg. 2008;  47 1181-1186 discussion 1186–1187