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Color Doppler ultrasound for surveillance following EVAR as the primary tool
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  • HAKKI ISCAN,
  • Ertekin Unal,
  • Boğaçhan Akkaya,
  • Mustafa Daglı,
  • Mehmet Karahan,
  • İsa Civelek,
  • Mehmet Hamdi Ozbek,
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HAKKI ISCAN
Turkey Yuksek Ihtisas Hospital
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Ertekin Unal
Turkey Yuksek Ihtisas Hospital
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Boğaçhan Akkaya
Turkey Yuksek Ihtisas Hospital
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Mustafa Daglı
Turkey Yuksek Ihtisas Hospital
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Mehmet Karahan
Turkiye Yuksek Ihtisas Hastanesi
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İsa Civelek
Turkey Yuksek Ihtisas Hospital
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Mehmet Hamdi Ozbek
Turkey Yuksek Ihtisas Hospital
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TURKIYE YUKSEK IHTISAS HASTANESI
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Abstract

Objective.As aneurysm related events and rupture is not eliminated, postoperative lifelong surveillance is mandatory after endovascular aneurysm repair(EVAR).For surveillance colored Doppler ultrasound(CDUS) is a standard method of noninvasive evaluation having the advantages of availability, cost-effectiveness and lack of nephrotoxicity and radiation.We evaluated CDUS for primary surveillance tool after elective EVAR by comparing with computerized tomography. Methods.Between 2018-2020, 84 consecutive post-EVAR patients were evaluated.Firstly, CDUS was performed by two Doppler operators from the Radiology and computed tomographic angiography (CTA) was performed.A reporting protocol was organized for endoleak detection and largest aneurysm diameter. Results.Among 84 patients, there were 11 detected endoleaks(13,1%) with CTA and 7 of them was detected with CDUS (r=0,884,p<0.001).There is an insufficiency in detecting low flow by CDUS.Eliminating this frailty, there was a strong correlation of aneurysm sac diameter measurement between CTA and CDUS (r=0,777,p<0,001).The sensitivity and specificity of CDUS was 63,6% and 100% respectively.The accuracy was 95,2%.Positive and negative predictive values were 100% and 94,8%.Bland-Altman analysis and linear regression analysis showed no proportional bias (mean difference of 1.5±2.2mm,p=0.233). Conclusions.CDUS promises accurate results without missing any potential complication requiring intervention as Type I or III endoleak.Lack of detecting type II endoleaks may be negligible as sac enlargement was the key for reintervention in this situation and CDUS has a remarkably high correlation with CTA in sac diameter measurement. CDUS may be a primary surveillance tool for EVAR and CTA will be reserved in case of aneurysm sac enlargement,detection of an endoleak,inadequate CDUS or in case of unexplained abdominal symptomatology

Peer review status:Published

13 Sep 2020Submitted to Journal of Cardiac Surgery
28 Sep 2020Assigned to Editor
28 Sep 2020Submission Checks Completed
05 Oct 2020Reviewer(s) Assigned
19 Oct 2020Review(s) Completed, Editorial Evaluation Pending
20 Oct 2020Editorial Decision: Accept
Jan 2021Published in Journal of Cardiac Surgery volume 36 issue 1 on pages 111-117. 10.1111/jocs.15194