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Wu H, Cheng Y, Gao W, Chen P, Wei Y, Zhao H, Wang F. Progress in the application of ultrasound in glioma surgery. Front Med (Lausanne) 2024; 11:1388728. [PMID: 38957299 PMCID: PMC11218567 DOI: 10.3389/fmed.2024.1388728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024] Open
Abstract
Brain glioma, which is highly invasive and has a poor prognosis, is the most common primary intracranial tumor. Several studies have verified that the extent of resection is a considerable prognostic factor for achieving the best results in neurosurgical oncology. To obtain gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of existing devices, it is imperative to develop a real-time image-guided resection technique to offer reliable functional and anatomical information during surgery. At present, the application of intraoperative ultrasound (IOUS) has been indicated to enhance resection rates and maximize brain function preservation. IOUS, which is promising due to its lower cost, minimal operational flow interruptions, and lack of radiation exposure, can enable real-time localization and precise tumor size and form descriptions while assisting in discriminating residual tumors and solving brain tissue shifts. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound (CEUS), three-dimensional ultrasound (3DUS), noninvasive ultrasound (NUS), and ultrasound elastography (UE), could assist in achieving GTR in glioma surgery. This article reviews the advantages and disadvantages of IOUS in glioma surgery.
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Affiliation(s)
| | | | | | | | | | | | - Fenglu Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Xi’an Medical University, Xi’an, China
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2
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Bachrati PZ, La Torre G, Chowdhury MM, Healy SJ, Singh AA, Boyle JR. A State-of-the-Art Review of Intra-Operative Imaging Modalities Used to Quality Assure Endovascular Aneurysm Repair. J Clin Med 2023; 12:3167. [PMID: 37176608 PMCID: PMC10179131 DOI: 10.3390/jcm12093167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Endovascular aortic aneurysm repair (EVAR) is the preferred method for elective abdominal aortic aneurysm (AAA) repair. However, the success of this technique depends greatly on the technologies available. Intra-operative imaging is essential but can come with limitations. More complex interventions lead to longer operating times, fluoroscopy times, and greater contrast doses. A number of intra-operative imaging modalities to quality assure the success of EVAR have been developed. A systematic literature search was performed with separate searches conducted for each imaging modality in the study: computed tomography (CT), digital subtraction angiography (DSA), fusion, ultrasound, intra-operative positioning system (IOPS), and non-contrast imaging. CT was effective at detecting complications but commonly resulted in increased radiation and contrast dose. The effectiveness of DSA can be increased, and radiation exposure reduced, through the use of adjunctive technologies. We found that 2D-3D fusion was non-inferior to 3D-3D and led to reduced radiation and contrast dose. Non-contrast imaging occasionally led to higher doses of radiation. Ultrasound was particularly effective in the detection of type II endoleaks with reduced radiation and contrast use but was often operator dependent. Unfortunately, no papers made it past full text screening for IOPS. All of the imaging techniques discussed have advantages and disadvantages, and clinical context is relevant to guide imaging choice. Fusion and ultrasound in particular show promise for the future.
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Affiliation(s)
- Petra Z. Bachrati
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- School of Clinical Medicine, Cambridge University, Cambridge CB2 0SP, UK
| | - Guglielmo La Torre
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Mohammed M. Chowdhury
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Samuel J. Healy
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- School of Clinical Medicine, Cambridge University, Cambridge CB2 0SP, UK
| | - Aminder A. Singh
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Jonathan R. Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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3
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Alexander LF, Overfield CJ, Sella DM, Clingan MJ, Erben YM, Metcalfe AM, Robbin ML, Caserta MP. Contrast-enhanced US Evaluation of Endoleaks after Endovascular Stent Repair of Abdominal Aortic Aneurysm. Radiographics 2022; 42:1758-1775. [PMID: 36190857 DOI: 10.1148/rg.220046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ruptured abdominal aortic aneurysm (AAA) carries high morbidity and mortality. Elective repair of AAA with endovascular stent-grafts requires lifetime imaging surveillance for potential complications, most commonly endoleaks. Because endoleaks result in antegrade or retrograde systemic arterialized flow into the excluded aneurysm sac, patients are at risk for recurrent aneurysm sac growth with the potential to rupture. Multiphasic CT has been the main imaging modality for surveillance and symptom evaluation, but contrast-enhanced US (CEUS) offers a useful alternative that avoids radiation and iodinated contrast material. CEUS is at least equivalent to CT for detecting endoleak and may be more sensitive. The authors provide a general protocol and technical considerations needed to perform CEUS of the abdominal aorta after endovascular stent repair. When there are no complications, the stent-graft lumen has homogeneous enhancement, and no contrast material is present in the aneurysm sac outside the stented lumen. In patients with an antegrade endoleak, contrast material is seen simultaneously in the aneurysm sac and stent-graft lumen, while delayed enhancement in the sac is due to retrograde leak. Recognition of artifacts and other potential pitfalls for CEUS studies is important for examination performance and interpretation. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Lauren F Alexander
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Cameron J Overfield
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - David M Sella
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - M Jennings Clingan
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Young M Erben
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Allie M Metcalfe
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Michelle L Robbin
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Melanie P Caserta
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
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Illuminati G, Nardi P, Fresilli D, Sorrenti S, Lauro A, Pizzardi G, Ruggeri M, Ulisse S, Cantisani V, D'Andrea V. Fully Ultrasound-Assisted Endovascular Aneurysm Repair (EVAR): preliminary report. Ann Vasc Surg 2022; 84:55-60. [PMID: 35257913 DOI: 10.1016/j.avsg.2022.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reducing fluoroscopy times and iodine contrast administration during endovascular exclusion (EVAR) of infrarenal aortic aneurysms (AAA) remains a challenge. The purpose of this study was to evaluate the preliminary results of a fully ultrasound-assisted EVAR without iodine contrast administration. METHODS Twentyseven consecutive patients, underwent an elective IVUS-assisted EVAR with final CEUS control of correct aneurysm exclusion. In no case intraprocedural injection of iodine contrast medium was performed. The primary study's endpoints were the overall duration of the procedure, duration of fluoroscopy, cumulative radiation dose, the length of intraoperative CEUS control and the comparison of findings between intraoperative CEUS and CT-scan at one month. RESULTS Mean duration of the procedure was 130 ± 35 minutes. Overall duration of fluoroscopy was 22 ± 18 minutes. Mean radiation dose was 66 mGy (range, 24 - 82). The mean length of CEUS final control was 8 ± 2 minutes. No type I or type III endoleak was detected either at CEUS or at angio-CT scan at one month from EVAR. CEUS revealed a type II endoleak in 6 patients (22%) , compared to 9 type II endoleaks (33%) detected at angio-CT scan one month after the procedure (p = 0.5). CONCLUSIONS Fully ultrasound (IVUS and CEUS) -assisted EVAR is safe, feasible and reliable, completely eliminating the need for iodine contrast medium and reducing the radiation exposure for both patients and surgeons.
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Affiliation(s)
| | | | | | | | | | - Giulia Pizzardi
- The Unit of Vascular Surgery, "San Camillo De Lellis" Hospital, Rieti, Italy
| | - Massimo Ruggeri
- The Unit of Vascular Surgery, "San Camillo De Lellis" Hospital, Rieti, Italy
| | | | - Vito Cantisani
- Radiology, the University of Rome "La Sapienza" , Rome, Italy
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Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6651726. [PMID: 33954192 PMCID: PMC8068524 DOI: 10.1155/2021/6651726] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/30/2022]
Abstract
Gliomas are the most invasive and fatal primary malignancy of the central nervous system that have poor prognosis, with maximal safe resection representing the gold standard for surgical treatment. To achieve gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of currently available equipment, developing a real-time image-guided resection technique that provides reliable functional and anatomical information during intraoperative settings is imperative. Nowadays, the application of intraoperative ultrasound (IOUS) has been shown to improve resection rates and maximize brain function preservation. IOUS, which presents an attractive option due to its low cost, minimal operational flow interruptions, and lack of radiation exposure, is able to provide real-time localization and accurate tumor size and shape descriptions while helping distinguish residual tumors and addressing brain shift. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound, three-dimensional ultrasound, navigable ultrasound, ultrasound elastography, and functional ultrasound, could help to achieve GTR during glioma surgery. The current review describes current advancements in ultrasound technology and evaluates the role and limitation of IOUS in glioma surgery.
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Tantawy TG, Seriki D, Rogers S, Katsogridakis E, Ghosh J. Endovascular Aneurysm Repair Assisted by CO 2 Digital Subtraction Angiography and Intraoperative Contrast-Enhanced Ultrasonography: Single-Center Experience. Ann Vasc Surg 2020; 70:459-466. [PMID: 32599109 DOI: 10.1016/j.avsg.2020.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease are major limitations to endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). We describe our experience combining CO2-assisted EVAR with intraoperative contrast-enhanced ultrasound (CEUS) in an attempt to avoid contrast-induced allergy or nephropathy. METHODS Observational cohort study using prospectively acquired data on patients undergoing CO2-assisted EVAR in single institution. EVAR planning was performed using computed tomographic angiography or magnetic resonance aortography in patients contraindicated for IC. Patients were considered if their estimated glomerular filtration rate was <40 mL/min and anatomically suitable for conventional infrarenal EVAR. Outcomes of interest included technical success rate and reintervention rates, total radiation dose, length of hospital stay, and graft kinking or migration. RESULTS Fifteen patients (10 male) were treated across a 5-year period. Technical success was achieved in all cases. Completely IC-free EVAR was performed in 9 cases, whereas the remaining 6 required IC administration for adjunct procedures. CO2 completion angiography detected all type I endoleaks (2 Ia and 1 Ib) but was less sensitive to type II. Intraoperative CEUS confirmed all type I and 2 cases of type II endoleaks. Median hospital stay was 4 days. No significant deterioration in renal function was seen postoperatively. CONCLUSIONS In patients with abdominal aortic aneurysms and with contraindication for IC, a combined approach of using CO2 digital subtraction angiography and CEUS can be used safely and efficiently to minimize or obviate the need for IC agents with satisfactory mid-term results.
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Affiliation(s)
- Tamer Ghatwary Tantawy
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Dare Seriki
- Department of Interventional Radiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Steven Rogers
- Independent Vascular Services Ltd, The Vascular Studies Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Academic Surgery Unit, Division of Cardiovascular Sciences, The University of Manchester, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emmanuel Katsogridakis
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan Ghosh
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Peroperative Intravascular Ultrasound for Endovascular Aneurysm Repair versus Peroperative Angiography: A Pilot Study in Fit Patients with Favorable Anatomy. Ann Vasc Surg 2019; 64:54-61. [PMID: 31726201 DOI: 10.1016/j.avsg.2019.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to compare intravascular ultrasound (IVUS) assistance for endovascular aortic aneurysm repair (EVAR) to standard assistance by angiography. METHODS From June 2015 to June 2017, 173 consecutive patients underwent EVAR. In this group, 69 procedures were IVUS-assisted with X-ray exposure limited to completion angiography for safety purposes because an IVUS probe does not yet incorporate a duplex probe (group A), and 104 were angiography-assisted procedures (group B). All IVUS-assisted procedures were performed by vascular surgeons with basic duplex ultrasound (DUS) training. The primary study endpoints were mean radiation dose, duration of fluoroscopy, amount of contrast media administered, procedure-related outcomes, and renal clearance expressed as the glomerular filtration rate (GFR) before and after the procedure. Secondary endpoints were operative mortality, morbidity, and arterial access complications. RESULTS Mean duration of fluoroscopy time was significantly lower for IVUS-assisted procedures (24 ± 15 min vs. 40 ± 30 min for angiography-assisted procedures, P < 0.01). Moreover, mean radiation dose (Air KERMA) was significantly lower in IVUS-assisted procedures (76m Gy [44-102] vs. 131 mGy [58-494]), P < 0.01. IVUS-assisted procedures required fewer contrast media than standard angiography-assisted procedures (60 ± 20 mL vs. 120 ± 40 mL, P < 0.01). The mean duration of the procedure was comparable in the two groups (120 ± 30 min vs. 140 ± 30 min, P = 0.07). No difference in renal clearance before and after the procedure was observed in either of the two groups (99.0 ± 4/97.8 ± 2 mL/min in group A and 98.0 ± 3/97.6 ± 5 mL/min in group B) (P = 0.28). The mean length of follow-up was nine months (6-30 months). No postoperative mortality, morbidity, or arterial access complications occurred. No type 1 endoleak was observed. Early type II endoleaks were observed in 21 patients (11%), 12 in the angiography-assisted group (11%) and nine in the IVUS-assisted group (12%). They were not associated with sac enlargement ≥5 mm diameter and therefore did not require any additional treatment. CONCLUSIONS Compared with standard angiography-assisted EVAR, IVUS significantly reduces renal load with contrast media, fluoroscopy time, and radiation dose while preserving endograft deployment efficiency. Confirmation from a large prospective study with improved IVUS probes will be required before IVUS-assisted EVAR alone can become standard practice.
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Keschenau PR, Alkassam H, Kotelis D, Jacobs MJ, Kalder J. Intraoperative contrast-enhanced ultrasound examination for endoleak detection after complex and infrarenal endovascular aortic repair. J Vasc Surg 2019; 71:1200-1206. [PMID: 31492615 DOI: 10.1016/j.jvs.2019.07.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this pilot study was to evaluate intraoperative contrast-enhanced ultrasound (iCEUS) examination for endoleak (EL) detection after complex endovascular aortic repairs (EVAR) in comparison with the standard angiographic completion control. METHODS Twenty-one patients (16 male; median age, 73 years [range, 54-81 years]) who underwent single-stage EVARs at our center between October 2016 and October 2018 were included prospectively. The procedures comprised fenestrated and/or branched EVAR (n = 14; 66%), infrarenal EVAR (n = 5; 24%), infrarenal EVAR with bilateral iliac side branch implantation (n = 1; 5%), and infrarenal EVAR with occluder implantation into the internal iliac artery (n = 1; 5%). The used endografts included 14 custom made devices (Cook, Australia Pty Ltd, Brisbane, Australia, n = 6; Vascutek Terumo, Glasgow, Scotland, n = 8) and seven standard infrarenal endografts (Medtronic Inc, Santa Rosa, Calif, n = 5; Vascutek Terumo, Glasgow, Scotland, n = 1; Cook, n = 1). All patients underwent an angiographic completion control for EL detection followed by iCEUS examination. The iCEUS examination was performed by the same examiner who was blinded to the angiography result. In addition to the comparison of the angiographic results to iCEUS examination, iCEUS examination was also compared with the computed tomography angiography (CTA) before discharge (median time to CTA, 5 days [range, 1-7 days]). RESULTS Angiography detected eight type II EL, defining the EL origin in four cases. In addition to detecting all of those eight EL, iCEUS examination revealed eight more type II EL not seen on angiography (P = .002) and allowed a definition of the EL origin in all cases. CTA before discharge showed a persistence of only 5 of the 16 type II EL detected by iCEUS examination (31%, P = .002). CONCLUSIONS An iCEUS examination can be used as another adjunct to decrease exposure to contrast agent and radiation during EVAR, including complex procedures. A replacement of the completion angiography by iCEUS examination is conceivable for infrarenal EVAR, but also for endovascular type IV or type V repairs. Future studies with larger patient numbers will help to further validate iCEUS examination during complex EVAR.
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Affiliation(s)
- Paula R Keschenau
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Hussam Alkassam
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, AZM Maastricht, Maastricht, The Netherlands.
| | - Johannes Kalder
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
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Rogers S, Lowe C, Carreira J, McCollum C, Ghosh J. Comparison of Contrast-Enhanced Tomographic 3-D Ultrasound Against Rotational Angiography Imaging Immediately After Endovascular Aneurysm Repair. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2356-2362. [PMID: 31253465 DOI: 10.1016/j.ultrasmedbio.2019.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
This proof of principle study assesses the utility of contrast-enhance ultrasound (CEUS) and contrast-enhanced tomographic 3-D ultrasound (CEtUS), as an intra-procedural imaging tool after endovascular-aneurysm repair (EVAR), compared with rotational angiography. A total of 20 consecutive patients undergoing infra-renal EVAR underwent immediate post-deployment rotational angiography, followed by CEUS and CEtUS scans. Outcomes were presence of endoleak, renal artery patency and endograft deformity. CEUS and CEtUS detected 12 endoleaks, 8 of which were not detected by rotational angiography. CEUS and CEtUS classify 7 or 8 type IIb endoleaks not detected by rotational angiography. CEUS/CEtUS could not identify 12 and 13 renal arteries, respectively, detected by rotational angiography. Rotational angiography and CEtUS both identified 1 endograft limb deformity, corrected immediately. CEUS and CEtUS are more sensitive to type II endoleak than rotational angiography, although there is a lower detection of renal arteries. CEUS or CEtUS has the utility for immediate post-EVAR endoleak detection where reduction of contrast agent is indicated.
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Affiliation(s)
- Steven Rogers
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK; Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK.
| | - Christopher Lowe
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - Joao Carreira
- Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK
| | - Charles McCollum
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK; Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jonathan Ghosh
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Gallitto E, Faggioli G, Gargiulo M, Freyrie A, Pini R, Mascoli C, Ancetti S, Vento V, Stella A. Planning, Execution, and Follow-up for Endovascular Aortic Aneurysm Repair Using a Highly Restrictive Iodinated Contrast Protocol in Patients with Severe Renal Disease. Ann Vasc Surg 2017. [PMID: 28648650 DOI: 10.1016/j.avsg.2017.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The cumulative amount of iodinated contrast medium necessary for endovascular repair (EVAR) planning, operative procedure, and subsequent follow-up is a threat for the onset of end-stage renal disease in patients with preoperative impaired kidney function. The purpose of this study was to describe a mini-invasive approach aimed to minimize the exposure of these patients to iodinated contrast medium and the subsequent risk of renal function worsening. METHODS From 2012 to 2015, all patients with abdominal aortic aneurysm (AAA) at high surgical risk and fit for standard EVAR (simple aortic-iliac anatomy: proximal and distal neck length ≥15 mm, no severe angulation), underwent EVAR through the following "near-zero contrast" approach, if their glomerular filtration rate (GFR) was <30 mL/min: preoperative planning was performed by noncontrast-enhanced computed tomography and duplex ultrasound (DU); the origin of renal/hypogastric arteries and aortic bifurcation was evaluated and matched with vertebral bone landmarks and the endograft deployed accordingly, using <20 cc of isotonic iodinate contrast medium and contrast-enhancement DU (CEUS). Follow-up was by DU/CEUS at 1, 6, and 12 months. Primary end points were technical success (TS: renal/hypogastric artery patency, absence of type I/III endoleaks, iliac stenosis/kinking, intraoperative mortality, and conversion), 30-day mortality, and new onset of permanent dialysis with renal function evaluation at 1, 6, and 12 months. Secondary end points were type II endoleaks, reinterventions, AAA, and renal-related mortality during the follow-up. RESULTS Eighteen patients (median age: 74 years, interquartile range [IQR]: 6, male: 78%, American Society of Anaesthesiologists [ASA] IV: 100%) were enrolled. The median AAA diameter and preoperative GFR were 66 mm (IQR: 13) and 22 mL/min (IQR: 4), respectively. Infrarenal (n = 10) and suprarenal fixation (n = 8) endografts were implanted, with a mean dose of iodinate contrast medium injection of 18 mL (IQR) and 100% TS rate. Two type II endoleaks were detected at the completion CEUS. The median postoperative GFR was 22 mL/min (IQR: 5). No patients had GFR worsening ≥30% at 1 day and 30 days. The 30-day mortality was 11% (2 deaths for heart failure). At a median follow-up of 16 months (IQR: 8), no patients needed hemodialytic treatment and no endoleaks were detected. One patient died at 6 months for cancer and one at 13 months for myocardial infarction. No reinterventions or AAA and renal-related mortality occurred during the follow-up. CONCLUSIONS A "near-zero contrast" approach is feasible in EVAR for patients with simple aorto-iliac anatomy. Patients with very poor renal function may still undergo to successful procedures, avoiding renal function impairment.
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Affiliation(s)
- Enrico Gallitto
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Gianluca Faggioli
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Antonio Freyrie
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rodolfo Pini
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Mascoli
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Ancetti
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Vincenzo Vento
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Stella
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Zimmermann H, Rübenthaler J, Paprottka P, Paprottka K, Reiser M, Clevert D. Feasability of contrast-enhanced ultrasound with image fusion of CEUS and MS-CT for endovascular grafting in infrarenal abdominal aortic aneurysm in a single patient. Clin Hemorheol Microcirc 2017; 64:711-719. [DOI: 10.3233/ch-168045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Steuwe A, Geisbüsch P, Schulz CJ, Böckler D, Kauczor HU, Stiller W. Comparison of Radiation Exposure Associated With Intraoperative Cone-Beam Computed Tomography and Follow-up Multidetector Computed Tomography Angiography for Evaluating Endovascular Aneurysm Repairs. J Endovasc Ther 2016; 23:583-92. [DOI: 10.1177/1526602816649588] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare the radiation exposure associated with intraoperative contrast-enhanced cone-beam computed tomography (ceCBCT) acquisitions to standard 3-phase multidetector computed tomography (MDCT) angiography used for assessing technical success after endovascular aortic repair (EVAR). Methods: Effective doses (EDs) were calculated for 66 EVAR patients (mean age 71 years; 61 men) with a mean 27.7-kg/m2 body mass index (range 17–49) who had both intraoperative ceCBCT and postoperative 3-phase MDCT angiography between November 2012 and April 2015. In addition, EDs were directly determined using thermoluminescent dosimeters (TLDs) embedded in anthropomorphic phantoms with body mass indexes of 22 and 30 kg/m2. Effective doses were calculated by summing doses recorded by all TLDs corresponding to a specific tissue type before applying the International Commission on Radiological Protection (ICRP) 60 and 103 weighting factors. EDs were compared with each other for both imaging modalities as well as to TLD measurements. Results: Average EDs of the patient collective were 4.9±1.1 mSv for ceCBCT, 2.6±1.2 mSv for single-phase MDCT (46% decrease, covering solely the area of the implanted endograft), and 13.6±5.5 mSv for comprehensive 3-phase MDCT examinations (178% increase, anatomical coverage from the aortic arch to femoral artery bifurcation). EDs determined in phantom measurements ranged from 3.1 to 4.5 mSv for ceCBCT, amounting to 2.6 mSv for a single MDCT phase (15% to 40% decrease) using ICRP 60 conversion factors. Applying ICRP 103 factors resulted in higher values for ceCBCT and slightly lower ones for MDCT. Conclusion: ceCBCT offers the chance for immediate intraoperative revisions of endograft-related problems. Requiring only a single-phase acquisition, ceCBCT is associated with a considerable reduction in ED (50%–75%) compared to standard 3-phase MDCT angiography after EVAR. On the other hand, MDCT has a larger field of view and is associated with less radiation exposure for a single phase (reduction of 20%–60%) if only the stented region is covered; however, MDCT angiography also uses larger amounts of contrast.
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Affiliation(s)
- Andrea Steuwe
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Christof J. Schulz
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Wolfram Stiller
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Scaife M, Giannakopoulos T, Al-Khoury GE, Chaer RA, Avgerinos ED. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management. Front Surg 2016; 3:29. [PMID: 27303669 PMCID: PMC4882338 DOI: 10.3389/fsurg.2016.00029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/09/2016] [Indexed: 11/17/2022] Open
Abstract
Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy.
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Affiliation(s)
- Mark Scaife
- Division of Vascular Surgery, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | | | - Georges E Al-Khoury
- Division of Vascular Surgery, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
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Jawad N, Parker P, Lakshminarayan R. The role of contrast-enhanced ultrasound imaging in the follow-up of patients post-endovascular aneurysm repair. ULTRASOUND (LEEDS, ENGLAND) 2016; 24:50-9. [PMID: 27433275 PMCID: PMC4760610 DOI: 10.1177/1742271x15627303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/22/2015] [Indexed: 11/16/2022]
Abstract
Endovascular aneurysm repair is a minimally invasive technique for the treatment of abdominal aortic aneurysms. Patients who undergo endovascular aneurysm repair are potentially at risk of developing problems related to the graft such as the development of endoleaks. Endoleaks can cause expansion of the aneurysmal sac, which can potentially lead to rupture. It is for this reason that lifelong surveillance of patients is required to assess the graft and the aneurysmal sac. This article discusses the role of contrast-enhanced ultrasound in the follow-up of patients post-endovascular aneurysm repair. Contrast-enhanced ultrasound is rapidly becoming a powerful, accurate and cost-effective tool to complement computed tomography in the follow-up of endovascular aneurysm repair patients. Real-time imaging of contrast filling into the arterial system means that contrast-enhanced ultrasound is an excellent problem-solving tool, particularly when assessing for the type and anatomy of endoleaks. In some instances, contrast-enhanced ultrasound can detect endoleaks when other modalities are equivocal.
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Yu SQ, Wang JS, Chen SY, Liu XM, Li Y, Ding YM, Li XY, Sun YL, Chen H. Diagnostic significance of intraoperative ultrasound contrast in evaluating the resection degree of brain glioma by transmission electron microscopic examination. Chin Med J (Engl) 2015; 128:186-90. [PMID: 25591560 PMCID: PMC4837836 DOI: 10.4103/0366-6999.149194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Contrast-enhanced ultrasound is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. In order to evaluate the diagnostic significance of intraoperative contrast-enhanced ultrasound in assessing the resection degree of brain glioma by transmission electron microscopic (TEM) examination, it is important to have specific knowledge about contrast-enhanced ultrasound. Methods: Ultrasound contrast was applied in operations of 120 cases of brain glioma, to evaluate the degree of tumor resection. Biopsy tissues were obtained the suspicious residual tumors surrounding the tumor cavity. The sensitivity and specificity of the residual tumors were determined by the intraoperative ultrasound contrast according to TEM examination results. Results: There were 44 cases of low-grade gliomas and 76 cases of high-grade gliomas. Three hundred and sixty biopsy tissues were obtained. The sensitivity of intraoperative ultrasound contrast in diagnosing the residual tumor was 62.2%, while the specificity degree of it was 92.8%. The consistency coefficient of the ultrasound contrast diagnosis and TEM examination results was 0.584 (Kappa = 0.584), which was between 0.4 and 0.6, therefore it was of medium consistency. Conclusions: Intraoperative ultrasound contrast was of a high sensitivity and specificity in evaluating the excision degree of tumor. The consistency of the residual tumor rate detected, respectively, by ultrasound contrast and TEM examination was of medium consistency. The application of intraoperative ultrasound contrast can improve the resection rate of brain glioma.
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Affiliation(s)
| | - Ji-Sheng Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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16
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Abstract
Contrast-enhanced ultrasound (CEUS) is increasingly being used to evaluate patients with known or suspected atherosclerosis. The administration of a microbubble contrast agent in conjunction with ultrasound results in an improved image quality and provides information that cannot be assessed with standard B-mode ultrasound. CEUS is a high-resolution, noninvasive imaging modality, which is safe and may benefit patients with coronary, carotid, or aortic atherosclerosis. CEUS allows a reliable assessment of endocardial borders, left ventricular function, intracardiac thrombus and myocardial perfusion. CEUS results in an improved detection of carotid atherosclerosis, and allows assessment of high-risk plaque characteristics including intraplaque vascularization, and ulceration. CEUS provides real-time bedside information in patients with a suspected or known abdominal aortic aneurysm or aortic dissection. The absence of ionizing radiation and safety of the contrast agent allow repetitive imaging which is particularly useful in the follow-up of patients after endovascular aneurysm repair. New developments in CEUS-based molecular imaging will improve the understanding of the pathophysiology of atherosclerosis and may in the future allow to image and directly treat cardiovascular diseases (theragnostic CEUS). Familiarity with the strengths and limitations of CEUS may have a major impact on the management of patients with atherosclerosis.
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Affiliation(s)
- Arend F L Schinkel
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
| | - Mathias Kaspar
- Division of Angiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Daniel Staub
- Division of Angiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
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17
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Hertault A, Maurel B, Pontana F, Martin-Gonzalez T, Spear R, Sobocinski J, Sediri I, Gautier C, Azzaoui R, Rémy-Jardin M, Haulon S. Benefits of Completion 3D Angiography Associated with Contrast Enhanced Ultrasound to Assess Technical Success after EVAR. Eur J Vasc Endovasc Surg 2015; 49:541-8. [DOI: 10.1016/j.ejvs.2015.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/19/2015] [Indexed: 01/11/2023]
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18
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Krasznai AG, Sigterman TA, Bouwman LH. Contrast Free Duplex-Assisted EVAR in Patients with Chronic Renal Insufficiency. Ann Vasc Dis 2014; 7:426-9. [PMID: 25593631 DOI: 10.3400/avd.cr.14-00084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/20/2014] [Indexed: 11/13/2022] Open
Abstract
Renal insufficiency and allergy for iodinated contrast are the main contra-indications for Endovascular Aortic Repair (EVAR). Various techniques have been used to minimize utilization of contrast in order to prevent contrast induced nephropathy. EVAR can be performed without nephrotoxic contrast, using additional duplex-guidance. This report describes three cases of duplex-assisted EVAR in patients with chronic renal insufficiency.
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Affiliation(s)
| | - Tim A Sigterman
- Department of Surgery, Atrium Medical Centre, Heerlen, Netherlands
| | - Lee H Bouwman
- Department of Surgery, Atrium Medical Centre, Heerlen, Netherlands
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Endovascular Abdominal Aortic Aneurysm Repair Using Transvenous Intravascular US Catheter Guidance in Patients with Chronic Renal Failure. J Vasc Interv Radiol 2014; 25:702-6. [DOI: 10.1016/j.jvir.2013.12.561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/21/2013] [Accepted: 12/21/2013] [Indexed: 11/24/2022] Open
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Dindyal S, Kyriakides C. Duplex ultrasound with the implementation of contrast enhancement in selected cases is satisfactory for EVAR surveillance. J Endovasc Ther 2012; 19:844-6; author reply 846. [PMID: 23210887 DOI: 10.1583/jevt-12-4060l.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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de Bucourt M, Mühler M, Kröncke T, Hanel M, Weiss A, Hamm B, Hein P. Endoleak After Endovascular Aneurysm Repair: Evaluation of a Single-Acquisition CTA Protocol Using a Prebolus. J Endovasc Ther 2011; 18:771-8. [DOI: 10.1583/11-3489.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Clevert DA, Helck A, D’Anastasi M, Trumm C, Meimarakis G, Weidenhagen R, Kopp R, Jauch K, Reiser M. Ultraschallgesteuerte EVAR-Interventionen und Follow-up-Diagnostik mit der kontrastmittelgestützten Sonographie und der Bildfusion. GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00772-011-0892-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Clevert DA, Sommer WH, Zengel P, Helck A, Reiser M. Imaging of carotid arterial diseases with contrast-enhanced ultrasound (CEUS). Eur J Radiol 2011; 80:68-76. [PMID: 21354734 DOI: 10.1016/j.ejrad.2010.12.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
Carotid duplex ultrasound is the standard of care for the initial diagnosis of carotid artery bifurcation diseases. But in difficult examinations, carotid abnormalities are commonly encountered and may represent a diagnostic challenge in patients with clinical symptoms as well as in the follow up after carotid endarterectomy or carotid artery stenting. Contrast enhanced ultrasound (CEUS) with low mechanical index (low MI) is a promising new method in the diagnosis and follow up of pathological carotid diseases. Unlike most contrast agents used for magnetic resonance imaging or computed tomography, the microbubbles used in CEUS with SonoVue(®) remain within the vascular space and hence can be used to study vascular disease. In addition to improving current carotid structural scans, CEUS has potential to improve or add extra information on carotid arterial diseases. This review describes the current carotid duplex ultrasound examination and compares the pathological findings with CEUS.
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Affiliation(s)
- D A Clevert
- Department of Radiology, Klinikum Grosshadern, University of Munich, Munich 81377, Germany.
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Dindyal S. Comments regarding "A retrospective study of intravascular ultrasound use in patients undergoing endovascular aneurysm repair: its usefulness and a description of the procedure" The use of Contrast Enhanced Ultrasound for Intra-procedural EVAR deployment completely eliminates the need for nephrotoxic iodinated intra-arterial contrast. Eur J Vasc Endovasc Surg 2011; 41:571; author reply 571-2. [PMID: 21247783 DOI: 10.1016/j.ejvs.2010.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 12/06/2010] [Indexed: 11/28/2022]
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