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Detecting Endoleaks in Aortic Endografts Using Contrast-Enhanced Sonography

Marcus J. Dill-Macky1, Stephanie R. Wilson, Yarron Sternbach, John Kachura and Thomas Lindsay

1 All authors: University Health Network, Mount Sinai Hospital, University of Toronto; and Division of Abdominal Imaging, Princess Margaret Hospital 3-923, 610 University Ave., Toronto, ON M5G 2M9, Canada.


Figure 1
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  		Fig. 1A —75-year-old man with type III endoleak. Figures S1G and S1H are available in supplemental data. Images from arterial phase contrast-enhanced sonography cine loop sweep show endoleak (arrows) between enhancing iliac limbs of endograft.

 

Figure 2
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  		Fig. 1B —75-year-old man with type III endoleak. Figures S1G and S1H are available in supplemental data. Images from arterial phase contrast-enhanced sonography cine loop sweep show endoleak (arrows) between enhancing iliac limbs of endograft.

 

Figure 3
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  		Fig. 1C —75-year-old man with type III endoleak. Figures S1G and S1H are available in supplemental data. Images from arterial phase contrast-enhanced sonography cine loop sweep show endoleak (arrows) between enhancing iliac limbs of endograft.

 

Figure 4
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  		Fig. 1D —75-year-old man with type III endoleak. Figures S1G and S1H are available in supplemental data. Axial arterial phase CT angiography (CTA) images, which correspond to A-C, show exact concordance in depiction of endoleak (arrows) between two imaging techniques.

 

Figure 5
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  		Fig. 1E —75-year-old man with type III endoleak. Figures S1G and S1H are available in supplemental data. Axial arterial phase CT angiography (CTA) images, which correspond to A-C, show exact concordance in depiction of endoleak (arrows) between two imaging techniques.

 

Figure 6
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  		Fig. 1F —75-year-old man with type III endoleak. Figures S1G and S1H are available in supplemental data. Axial arterial phase CT angiography (CTA) images, which correspond to A-C, show exact concordance in depiction of endoleak (arrows) between two imaging techniques.

 

Figure 7
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  		Fig. 2A —87-year-old man with subtle type II endoleak from left lumbar artery. Figure S2E can be viewed in supplemental data. Axial contrast-enhanced sonography image at level of iliac components of endograft depicts suspicious bright area (arrow) at periphery of aneurysmal sac.

 

Figure 8
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  		Fig. 2B —87-year-old man with subtle type II endoleak from left lumbar artery. Figure S2E can be viewed in supplemental data. By applying brief high-mechanical-index pulse, all contrast agent bubbles in field of view are disrupted, thereby producing bright flash (arrow) (destruction-reperfusion technique).

 

Figure 9
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  		Fig. 2C —87-year-old man with subtle type II endoleak from left lumbar artery. Figure S2E can be viewed in supplemental data. Axial contrast-enhanced sonography image at same level as A and B obtained immediately after high-mechanical index pulse reveals absence of previously described suspected enhancement, indicating presence of endoleak.

 

Figure 10
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  		Fig. 2D —87-year-old man with subtle type II endoleak from left lumbar artery. Figure S2E can be viewed in supplemental data. Axial contrast-enhanced sonography image obtained at same level as A-C shows return of microbubbles (arrow) to that region after short delay.

 

Figure 11
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  		Fig. 3A —86-year-old man with type I endoleak detected at contrast-enhanced sonography but occult at CT angiography (CTA). Axial arterial phase contrast-enhanced sonography image reveals subtle endoleak (arrow) adjacent to left iliac limb of endograft.

 

Figure 12
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  		Fig. 3B —86-year-old man with type I endoleak detected at contrast-enhanced sonography but occult at CT angiography (CTA). Axial contrast-enhanced sonography image obtained at same level as A acquired 2 minutes after contrast injection depicts larger endoleak (arrows) than that shown in arterial phase (A).

 

Figure 13
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  		Fig. 3C —86-year-old man with type I endoleak detected at contrast-enhanced sonography but occult at CT angiography (CTA). Axial arterial phase (C) and 2-minute delayed phase (D) CTA images at same level as two previous images in retrospect reveals subtle evidence of endoleak (arrow, D) depicted at contrast-enhanced sonography.

 

Figure 14
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  		Fig. 3D —86-year-old man with type I endoleak detected at contrast-enhanced sonography but occult at CT angiography (CTA). Axial arterial phase (C) and 2-minute delayed phase (D) CTA images at same level as two previous images in retrospect reveals subtle evidence of endoleak (arrow, D) depicted at contrast-enhanced sonography.

 

Figure 15
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  		Fig. 4A —81-year-old man with large transient type I endoleak. Figure S4E is available in supplemental data. Axial contrast-enhanced sonography image at level of iliac components shows endoleak (arrow).

 

Figure 16
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  		Fig. 4B —81-year-old man with large transient type I endoleak. Figure S4E is available in supplemental data. Sagittal contrast-enhanced sonography images along graft with duplex Doppler imaging depict large high-flow endoleak anterior to aortic component of graft with relatively damped pulse Doppler waveform (arrow, C).

 

Figure 17
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  		Fig. 4C —81-year-old man with large transient type I endoleak. Figure S4E is available in supplemental data. Sagittal contrast-enhanced sonography images along graft with duplex Doppler imaging depict large high-flow endoleak anterior to aortic component of graft with relatively damped pulse Doppler waveform (arrow, C).

 

Figure 18
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  		Fig. 4D —81-year-old man with large transient type I endoleak. Figure S4E is available in supplemental data. Arterial phase CT angiography image obtained at same level as B and C 1 day after B and C reveals no evidence of leak, which is confirmed at repeat contrast-enhanced sonography (not shown).

 

Figure 19
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  		Fig. 5A —88-year-old woman with subtle type II endoleak. Axial contrast-enhanced sonography image obtained at level of iliac endograft components reveals subtle endoleak (arrow) not identified prospectively in blinded interpretation (false-negative).

 

Figure 20
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  		Fig. 5B —88-year-old woman with subtle type II endoleak. Arterial phase CT angiogram obtained at same level as A shows endoleak (arrow), which was detected prospectively.

 

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