PURPOSE: To compare standardised 2D ultrasound (US) to the novel ultrasonographic imaging techniques 3D/4D US and image fusion (combined real-time display of B mode and CT scan) for routine measurement of aortic diameter in follow-up after endovascul

Objective: Is Contrast Harmonic Imaging (CHI) comparable to computed tomography angiography (CTA) scan in detecting and characterizing suspected endoleaks after endovascular abdominal aneurysm repair in a non-selected group including reintervention procedure and branched endografts in daily practice? Material/methods: In a prospective study computed tomography angiography (CTA) and contrast-enhanced ultrasound (CEUS) were performed in 30 consecutive patients (26 males, 4 females, mean age: 72 years, range: 38–87) with suspected endoleaks in follow-up (mean 13 months, range: 1–95) after endovascular abdominal aneurysm repair or procedure in dissection or penetrated ulcer of the aorta (25 infrarenal, 5 suprarenal stent grafts, mean aortic diameter 56 mm, range: 27–98). CTA was supposed to be gold standard for determining the presence of endoleaks (multislice CT, collimation 16 × 0.75 mm, 100 ml of iodized contrast agent bolus). Ultrasonography used a multi-frequency probe (1–4 MHz) with the modalities of colour coded Doppler sonography (CCDS), power Doppler (PD) combined with contrast enhancement and the technique of contrast harmonic imaging (CHI) and low mechanical index (MI < 0.2). 2.4 ml of SonoVue ^® (Bracco, Altana Pharma GmbH, Italy) were administered to each patient intravenously as a bolus injection. Results: Out of 30 patients, 21 endoleaks were identified in CTA (6 type I or III, 15 type II), 22 in CHI. Thus, sensitivity for CHI was therefore 99%, its specificity 85% (Spearman correlation coefficient (CC) 0.92). In follow-up the localizations of endoleak type I or III exclusively detected by CHI were confirmed as true positive by angiography. Due to its dynamic characteristic CHI seemed to be more helpful in characterization of endoleaks than CTA. In case of a rupture after reintervention a type III endoleak leads to prompt intervention before receiving the result of the CT scan. Altogether, CHI failed to identify 1 combined type I and II endoleak (sensitivity 0.99). Both, CCDS and PD were positive only in 6/30 patients (CC 0.33 and 0.39). Interestingly the application of contrast agent doubles the detection rate of endoleaks (12/30) in CCDS and PD (CC 0.39). Conclusion: Contrast harmonic imaging (CHI) compared to computed tomography angiography (CTA) accurately depicts endoleaks after endovascular abdominal aneurysm repair and stent-graft procedure in dissected and ulcerated aorta. It seems to be superior in characterization of the type of endoleaks and can be established in order to reduce iodized contrast agent and radiation exposure in follow-up. In contrast to CTA scan CHI can be offered to patients with chronic renal insufficiency and allows a dynamic examination and a perfusion analysis.

Objectives: To present our experience with various therapeutic approaches for the treatment of secondary aortoenteric fistulas following open and endovascular aortic aneurysm repair. Methods and Materials: A retrospective data analysis of patients treated for secondary aortoenteric fistulas in a single vascular institution between January 2005 and December 2018 was performed. Analyzed parameters included patients’ demographics, clinical presentation, diagnostic work-up, perioperative data and repair durability during follow-up. Results: Twenty-three patients with aortoenteric fistulas were treated in the target period. The fistulous connection was located in 21 cases (91.3%) in the duodenum and in two cases (8.7%) in the small intestine. Average time between the initial procedure and detection of the aortoenteric fistula was 69.4 ± 72.5 months. The most common presenting symptom was gastrointestinal bleeding (n = 12, 52.2%), followed by symptoms suggestive of chronic infection (n = 11, 47.8%). Open surgical repair was performed in 19 patients (bridging in 3 patients), and endovascular repair was carried out in two cases and one patient underwent a hybrid operation. One patient underwent abscess drainage due to significant comorbidities. Mean follow-up was 35.1 ± 35.5 months. In-hospital mortality and overall mortality were 43.5% (10/23) and 65.2% (15/23), respectively. Patients presenting with bleeding had a significantly higher perioperative mortality rate in comparison to patients presenting with chronic infection (66.7% (8/12) and 18.2% (2/11), respectively, p = 0.019). Patients who underwent stent-graft implantation for control of acute life-threatening bleeding showed significantly better perioperative survival in comparison to patients that were acutely treated with an open procedure (66.6%, (4/6) and 0% (0/6), respectively, p = 0.014). Perioperative mortality was also higher for ASA IV patients (71.4%, 5/7), when compared to ASA III Patients (31.2%, 5/16), although this did not reach statistical significance (p = 0.074). Conclusion: Treatment of secondary aortoenteric fistulas is associated with a high perioperative mortality rate. Patients who survive the perioperative period following open surgical repair in the absence of hemorrhagic shock show acceptable midterm results during follow-up. Stent-graft implantation for bleeding control in patients presenting with life-threatening bleeding seems to be associated with lower perioperative mortality rates.