Color duplex ultrasound evaluation of transluminally placed endovascular grafts for aneurysm repair

Transluminally placed endovascular stented grafts (TPEG's) have allowed minimally invasive repair of a wide range of arterial lesions. Although we have previously described our findings with color duplex ultrasound (CDU) of TPEG's for occlusive disease, CDU findings of TPEG repair for arterial aneurysms differ and have not been reported to date. We have therefore analyzed the results of 74 CDU scans in 40 patients undergoing 41 TPEG procedures for repair of aortic (33), iliac (6), subclavian (1), and popliteal (1) artery aneurysms. Following TPEG placement, CDU examination consisted of B-mode inspection and Doppler interrogation of the entire length of the TPEG, surrounding artery and adjacent inflow and outflow vessels. Particular attention was directed toward detecting persistent flow within the aneurysm sac (endoleak), determining graft and stent position (to exclude migration), graft patency and aneurysm size, and identifying stenotic lesions (pulsatile graft narrowing, extrinsic graft compression). CDU findings were compared to postoperative spiral computed tomography (CT) scans and contrast arteriography. Aneurysm size was reliably determined by both spiral CT and CDU. CDU detected all persistent endoleaks found on spiral CT scan or angiography. Two temporary midgraft endoleaks were seen on spiral CT but not by CDU or angiography, and there were two CDU false-positive endoleak examinations. Graft stenosis was most reliably identified by CDU. CDU is an effective technique for the assessment of endovascular grafts placed for the treatment of arterial aneurysms. It can be the principal diagnostic technique for postoperative surveillance of this evolving procedure.