Diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular abdominal aortic aneurysm repair
Wang Xinyu1, Zhao Guozheng1, Xu Juan2, Liu Shuping1, Li Li1.
1Department of Ultrasound, Air Force Medical Center, PLA, Beijing 100142, China; 2Department of Ultrasound, Tangshan People′s Hospital, Tangshan 063000, China
Abstract：ObjectiveTo explore the diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular repair of abdominal aortic aneurysm. MethodsRetrospective analysis of the clinical information of a patient with endoleak and left perirenal hematoma following endovascular repair of abdominal aortic aneurysm at the Cardiovascular Surgery Department of the Air Force Medical Center on May 6, 2022 was performed. The advantages of contrast-enhanced ultrasound in the diagnosis of endoleak were discussed, supported by relevant literature. ResultsA 54 year old male patient was admitted with complains of intermittent chest tightness, shortness of breath, and discomfort that had been present for 1 year and worsened for 1 week. Two years ago, the patient was found to have abdominal aortic aneurysm and underwent endovascular aneurysm repair. The general condition of the patient was poor after surgery. Conventional ultrasound showed aneurysmal dilatation of the abdominal aorta with stent echo, while color Doppler ultrasound showed red and blue vortex signals within the aneurysm. There was a hypoechoic mass in the left kidney, and color Doppler showed no obvious blood flow signal in it. Ultrasound contrast examination revealed that no obvious microbubbles entered the left perirenal mass. A microbubble entered the upper half of the perivascular mass around the left lateral wall at the upper end of the abdominal aortic stent and returned to the stent on the right lateral wall. Left perirenal hematoma detected on ultrasound, but no visible signs of ongoing bleeding. Active leakage (I a type endoleak) was visible in the tumor body following stenting for abdominal aortic aneurysm. Abdominal CT indicated the formation of an intramural hematoma at the aneurysm site, with encapsulated fluid accumulation in the left posterior kidney behind the peritoneum (considered a hematoma). The position of the sent was normal, and no abnormal density shadow was found. ConclusionFor patients with endoleak after endovascular aneurysm repair, contrast-enhanced ultrasound can observe the endoleak site in real time, which makes up for the shortcomings of conventional ultrasound and the lack of dynamic monitoring of enhanced CT, and provides accurate and effective imaging basis for the diagnosis of endoleak.
王昕禹1赵国政1徐娟2刘淑萍1李利1. 腹主动脉瘤腔内修复术后内漏与左肾周
血肿的超声造影诊断特征[J]. 中华诊断学电子杂志, 2023, 11(4): 239-243.
Wang Xinyu1, Zhao Guozheng1, Xu Juan2, Liu Shuping1, Li Li1.. Diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular abdominal aortic aneurysm repair. zhzdx, 2023, 11(4): 239-243.
［1］胡路,陈学明,刘明远,等.腔内修复术治疗复杂型腹主动脉瘤的疗效观察［J］.血管与腔内血管外科杂志,2022,8(6):656-659,670.DOI:10.19418/j.cnki.issn2096-0646.2022.06.04.
［2］王勇,孙岩.腹主动脉瘤腔内修复术后肠系膜下动脉来源Ⅱ型内漏的单中心回顾性分析［J/OL］.中国胸心血管外科临床杂志，2023（30）.［2023-04-13］.http://kns.cnki.net/kcms/detail/51.1492.r.20230411.1256.008.html.
［3］李文东,项广源,刘昭,等.开放手术治疗腹主动脉瘤腔内修复术后Ⅰa型内漏的体会［J/CD］.中国血管外科杂志（电子版）,2022,14(4):348-349,352.DOI:10.3969/j.issn.1674-7429.2022.04.014.
［4］Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension:summary of opinions expressed at an international conference［J］.J Vasc Surg,2002,35(5):1029-1035.DOI:10.1067/mva.2002.123095.
［5］Ultee K,Büttner S,Huurman R,et al.Editor′s choice-systematic review and meta-analysis of the outcome of treatment for type Ⅱ endoleak following endovascular aneurysm repair［J］.Eur J Vasc Endovasc Surg,2018,56(6):794-807.DOI:10.1016/j.ejvs.2018.06.009.
［6］Sidloff DA, Stather PW, Choke E, et al. Type Ⅱ endoleak after endovascular aneurysm repair［J］.Br J Surg,2013,100(10):1262-1270.DOI:10.1002/bjs.9181.
［7］张韬,郭伟.腹主动脉瘤诊断和治疗中国专家共识（2022版）［J］.中国实用外科杂志,2022,42(4):380-387.DOI:10.19538/j.cjps.issn1005-2208.2022.04.03.
［8］White GH,Yu W,May J.Endoleak-a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft［J］.J Endovasc Surg,1996,3(1):124-125.DOI:10.1583/1074-6218(1996)003＜0124b:＞2.0.CO;2.
［9］Brown A,Saggu GK,Bown MJ,et al.Type II endoleaks:challenges and solutions［J］.Vasc Health Risk Manag,2016（12）:53-63.DOI:10.2147/VHRM.S81275.
［10］张杰，戴向晨，肖明等.超声造影诊断腹主动脉瘤腔内隔绝术后Ⅰ、Ⅱ型内漏的价值［J］.中华超声医学杂志，2017，26(4)：296-301.DOI:10.3760/cma.j.issn.1004-4477.2017.04.005.
［11］Fransen GA,Sr VSR,van Marrewijk CJ,et al.Rupture of infra-renal aortic aneurysm after endovascular repair:a series from EUROSTAR registry［J］.Eur J Vasc Endovasc Surg,2003,26(5):487-493.DOI:10.1016/s1078-5884(03)00350-2.
［12］刘宁,洪玉才,章仲恒.超声造影在急危重症中的应用［J/CD］.中华诊断学电子杂志,2018,6(2):80-83.DOI:10.3877/cma.j.issn.2095-655X.2018.02.003.
［13］李文睿,李清乐,张小明,等.腹主动脉瘤腔内修复术后Ⅰ型内漏的处理［J］.中国微创外科杂志,2019,19(03):239-242.DOI:10.3969/j.issn.1009-6604.2019.03.012.
［14］Gürtler VM, Sommer WH, Meimarakis G, et al. A comparison between contrast-enhanced ultrasound imaging and multislice computed tomography in detecting and classifying endoleaks in the follow-up after endovascular aneurysm repair［J］.J Vasc Surg,2013,58(2):340-345.DOI:10.1016/j.jvs.2013.01.039.
［15］Badea R,Zaro R,Tan瘙塅u M,et al.Ultrasonography of the biliary tract - up to date.The importance of correlation between imaging methods and patients' signs and symptoms［J］.Med Ultrason,2015,17(3):383-391.DOI:10.11152/mu.2013.2066.173.rbd.
［16］中华医学会外科学分会血管外科学组.腹主动脉瘤诊断与治疗指南［J］.中国实用外科杂志,2008,28(11):916-918.DOI:10.3321/j.issn:1005-2208.2008.11.004.
［17］张波，田为中，窦小锋.双源CT大螺距扫描模式血管成像对主动脉病变的诊断价值［J/CD］.中华临床医师杂志(电子版)，2012，6(17)：5115-5117.DOI:10.3877/cam.j.issn.1674-0785.2012.21.096.
［18］肖明,张杰.超声造影在腹主动脉瘤腔内隔绝术后内漏诊断中的应用［J］.血管与腔内血管外科杂志,2016,2(5):440-443,449.DOI:10.19418/j.cnki.issn2096-0646.2016.05.19.
