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Surveillance of endovascular aneurysm repair: an audit of sonographer-led ultrasound and radiologist-led computed tomography services

机译：血管内动脉瘤修复的监测：由超声检查师领导的超声和放射科医师领导的计算机断层摄影服务的审计

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Objectives Postoperative complications associated with endovascular aneurysm repair (EVAR) mandate the need for lifelong surveillance. The aim of this audit was to compare the detection rates of endoleaks during the first 10 months of a combined sonographer-led colour Doppler ultrasound (CDUS) and radiologist-led contrast-enhanced computed tomography (CECT), postoperative EVAR surveillance programme, within a single National Health Service Hospital. nnMethods A prospective audit was carried out of all patients with EVAR, who had same-day CECT and CDUS surveillance examinations between March 2010 and January 2011. CECT examinations were reported by three consultant vascular radiologists. Of 66 CDUS examinations, 64 (97%) were performed and reported by four certified vascular sonographers. The reports of dual-modality, same-day scans were compared, to establish agreement on the presence and classification of the type, or absence of endoleaks. CECT was used as the gold standard, against which the sensitivity and specificity of CDUS in endoleak detection was determined. nnResults Sixty-six paired same-day CECT and CDUS reports were compared. Ten endoleaks were identified by CECT (15% incidence) and eight (80%) of 10 were type II. The number of observed agreements was 58 (88%) of 66; CDUS missed six endoleaks (five type II) and suggested two false-positives. CDUS had a sensitivity of 40% and a specificity of 96%. nnConclusions In our study, CDUS demonstrated an excellent specificity but had a low sensitivity for endoleak detection. We agree CDUS cannot effectively replace CECT as the sole imaging modality. Research to determine an international consensus for an effective and efficient postoperative EVAR surveillance patient pathway is required.
机译：目的与血管内动脉瘤修复（EVAR）相关的术后并发症要求进行终生监测。这次审核的目的是比较超声检查医师主导的彩色多普勒超声检查（CDUS）和放射科医生主导的造影增强计算机体层摄影术（CECT），术后EVAR监测程序在头10个月内内漏的检出率。单一的国家卫生服务医院。 nn方法对所有EVAR患者进行了前瞻性审计，这些患者在2010年3月至2011年1月之间进行了当天CECT和CDUS监视检查。三名顾问血管放射医师报告了CECT检查。在66例CDUS检查中，有64名（97％）进行了检查，并由四名获得认证的血管超声医师报告。比较了双模式，当天扫描的报告，以就类型的存在和分类或是否存在内漏达成一致。将CECT用作金标准，以此确定CDUS在内漏检测中的敏感性和特异性。 nn结果比较了66份配对的当天CECT和CDUS报告。通过CECT鉴定出10种内漏（发生率15％），其中10种中的8种（80％）属于II型。所观察到的协议数量为66的58（88％）； CDUS错过了6次内漏（5种II型），并提出了2次假阳性。 CDUS的敏感性为40％，特异性为96％。 nn结论在我们的研究中，CDUS表现出优异的特异性，但对内漏检测的敏感性较低。我们同意CDUS不能有效替代CECT作为唯一的影像学检查方法。需要进行研究以确定有效和高效的术后EVAR监测患者途径的国际共识。

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