Topics

Fusion of CT Angiography With 3D Contrast Ultrasound as a Method for Follow up for Endovascular Aneurysm Repair

2019-09-18 03:27:32 | BioPortfolio

Summary

Abdominal Aortic Aneurysm (AAA) is a known vascular entity that may be life threatening condition .The most common treatment approach nowadays is the endovascular approach, a procedure known as endovascular aortic repair (EVAR). The most common procedure related complication is the expansion of the aneurysm from a "feeding vessel", usually a lumbar or intercostal artery. Another known complication is an endoleak from the stentgraft.Today, accepted EVAR follow up protocol consists of a multiple multiphasic CT angiography (CTA) scan . Hazards of these follow up CTA exams include repetitive radiation exposure, nephrotoxicity and allergic reactions. Ultrasonography is a useful method for detection and evaluation of AAA, has no ionizing radiation and is useful for the dynamic estimation of the aortic width in patients post EVAR. However, the sensitivity of ultrasonography solely for detection of endoleaks in post EVAR patients is not high.In recent years, the development of "fusion" applications allows the dual modality merge between ultrasound and CT scans that can be used as follow up examinations of known imaging findings on CT .Another application that had been developed for ultrasound machines is the ability to generate a 3 dimensional (3D) reconstruction which allows more precision. In the recent year the usage of intravenous contrast agent for ultrasonography based on microbubbles (BRACO SONOVIEW) has been approved by the Israeli ministry of health. This contrast agent is not nephrotoxic and the risk for allergic reaction is very low statistically similar to Gadolinium.A 3D contrast enhanced ultrasonography "fused" together with CTA may be an appropriate substitute for the standard CTA follow up in post EVAR patients and thus substantially reduce radiation doses as well as iodine contrast reactions and nephrotoxicity . The purpose of our research is to evaluate the combined modality (fusion of CTA with CEUS) mentioned above in the manner of radiation exposure and possible contrast media related adverse reaction reduction, thus allowing this method to become the possible gold standard exam for follow up EVAR patients.

Description

Abdominal Aortic Aneurysm (AAA) is a known vascular entity that may be life threatening and requires treatment once it's diameter exceeds 5.5 cm or in any diameter in symptomatic patients.

Known risk factors for developing Abdominal Aortic Aneurysm (AAA) include tabacco consumption, Sex (male predominance), age (above 65 with a history of smoking or age above 75 without a history of smoking ), hypertension, diabetes mellitus and hyperchlesterolemia1 The most common treatment approach nowadays is the endovascular approach, a procedure known as endovascular aortic repair (EVAR). The most common procedure related complication is the expansion of the aneurysm from a "feeding vessel", usually a lumbar or intercostal artery. Another known complication is an endoleak from the stentgraft, through its proximal or distal part/.

Today, accepted EVAR follow up protocol consists of a multiphasic CT angiography (CTA) scan .The initial scan is performed without contrast, the second scan is performed in the arterial phase and a third scan is performed in the late (portal) phase. CTA is performed 3,6 and12 months after the procedure. After 12 months , follow up examinations are obtained annually. Hazards of these follow up CTA exams include repetitive radiation exposure, nephrotoxicity and allergic reactions.

Ultrasonography is a useful method for detection and evaluation of AAA and is recommended as an annual screening tool for patients above 65 with smoking history or above 75 without smoking history. Duplex Ultrasonography has no ionizing radiation and is useful for the dynamic estimation of the aortic width in patients post EVAR. However, the sensitivity of ultrasonography solely for detection of endoleaks in post EVAR patients is not high, mostly due to known inborn limitations of ultrasound including decreased penetration in obese patients , and suboptimal demonstration of retroperitoneal structures due to gas in the intestine.

In recent years, the development of "fusion" applications allow the dual modality merge between ultrasound and CT scans. The dual modality allows the direct comparison of imaging findings in real time. Fusion imaging is used as follow up examinations of known imaging findings on CT that cannot be optimally demonstrated on ultrasonography. Once these findings are followed up by ultrasonography, an substantial amount of radiation can be reduced.

Another application that had been developed for ultrasound machines nowadays is the ability to generate a 3 dimensional (3D) reconstruction which allows more precision. 2D and 3D ultrasound imaging as a follow up imaging modality after endovascular aortic repair (EVAR) procedures has been described in medical literature3,4.

In the recent year the usage of intravenous contrast agent for ultrasonography based on microbubbles (BRACO SONOVIEW) has been approved by the Israeli ministry of health. This intravenous contrast agent has been in usage for several years in Europe and have been recently approved officially in our country in the examination of liver, breast, vascular cerebral lesions and peripheral blood vessels. This contrast agent is not nephrotoxic and the risk for allergic reaction is very low statistically similar to Gadolinium. The contrast agent is purely intravascular and does not leak to the the interstitium, therefore can be used efficiently for the detection of endoleaks.

This contrast agent has yet to be approved by ministry of health for the application in aorta imaging. Nevertheless, the European federation of societies for ultrasound in medicine and biology (EFSUMB) has specific guidelines for the usage of this contrast agent for the detection of stent grafts endoleaks (5) .

A 3D contrast enhanced ultrasonography "fused" together with CTA may be an appropriate substitute for the standard CTA follow up in post EVAR patients and thus substantially reduce radiation doses as well as iodine contrast reactions and nephrotoxicity .

The purpose of our research is to evaluate the combined modality (fusion of CTA with CEUS) mentioned above in the manner of radiation exposure and possible contrast media related adverse reaction reduction, thus allowing this method to become the possible gold standard exam for follow up EVAR patients.

Study Design

Conditions

Abdominal Aortic Aneurysm

Intervention

Contrast 3D Ultrasound

Status

Not yet recruiting

Source

Rambam Health Care Campus

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-09-18T03:27:32-0400

Clinical Trials [2924 Associated Clinical Trials listed on BioPortfolio]

Evaluation of Contrast-Enhanced Ultrasound to Detect Endoleaks After Endovascular Aortic Aneurysm Repair

This study will be a cross-sectional survey of interobserver variability associated with contrast enhanced ultrasound (CEUS) to detect endoleaks using computed tomographic angiography (CTA...

Intraoperative Assessment of Pulsatile Aneurysm Wall Motion During Endovascular Aneurysm Repair

Endovascular abdominal aortic aneurysm repair (EVAR) aims to reduce the risk of aneurysm (AAA) rupture by reducing the blood pressure transmitted to the wall of the aneurysm. Aneurysms tha...

Safety and Efficacy Study of Abdominal Aortic Aneurysm Stent Graft System

A prospective, multi-centre, objective performance criteria clinical trial to evaluate the safety and efficacy of Abdominal Aortic Aneurysm Stent Graft System manufactured by Lifetech Scie...

Follow-up of Endovascular Aneurysm Treatment - The FEAT Trial

After endovascular abdominal aortic aneurysm repair, life-long follow-up is needed to monitor the effectiveness of exclusion of the aneurysm sac from blood flow. For this reason, aneurysm ...

Measurement of Maximum Diameter of Native Abdominal Aortic Aneurysm by Angio-CT

Screening for an abdominal aortic aneurysm, monitoring its growth and evaluation of its risk of rupture are based on the mesure of its maximum diameter. The abdominal aortic aneurysm's tre...

PubMed Articles [7654 Associated PubMed Articles listed on BioPortfolio]

Infected abdominal aortic aneurysm after trans-rectal ultrasound-guided biopsy of the prostate: a report of two cases.

Primary infected abdominal aortic aneurysm (AAA) is an uncommon presentation which can be associated with significant morbidity and mortality. In this report, we present two cases of infected AAA less...

An isolated aneurysm of the abdominal aorta in a patient with Marfan's syndrome - a case report.

We present a case of successfully treated abdominal aortic aneurysm in a 24-year old patient with Marfan's syndrome. Following initial physical and ultrasound examination, the multislice computed tomo...

Deep vein thrombosis secondary to abdominal aortic aneurysm: A case report.

Abdominal aortic aneurysm is an extremely rare cause of deep vein thrombosis. Here we report an elderly gentleman who presented with deep vein thrombosis and was found to have concomitant abdominal ao...

Combined transcatheter treatment of severe aortic valve stenosis and infrarenal abdominal aortic aneurysm in increased surgical risk patients.

The prevalence of combined severe aortic stenosis and abdominal aortic aneurysm is increasing with the ageing of the population. Both conditions are associated with adverse outcome if not adequately m...

CT and 3D-ultrasound registration for spatial comparison of post-EVAR abdominal aortic aneurysm measurements: A cross-sectional study.

The aim of the present study is to provide a methodology to register volumes of stented abdominal aortic aneurysm, imaged by 3D-US and CT modalities. After registration, the method enables to compare ...

Medical and Biotech [MESH] Definitions

An abnormal balloon- or sac-like dilatation in the wall of the ABDOMINAL AORTA which gives rise to the visceral, the parietal, and the terminal (iliac) branches below the aortic hiatus at the diaphragm.

The tearing or bursting of the wall along any portion of the AORTA, such as thoracic or abdominal. It may result from the rupture of an aneurysm or it may be due to TRAUMA.

Postoperative hemorrhage from an endovascular AORTIC ANEURYSM repaired with endoluminal placement of stent grafts (BLOOD VESSEL PROSTHESIS IMPLANTATION). It is associated with pressurization, expansion, and eventual rupture of the aneurysm.

Cardiovascular manifestations of SYPHILIS, an infection of TREPONEMA PALLIDUM. In the late stage of syphilis, sometimes 20-30 years after the initial infection, damages are often seen in the blood vessels including the AORTA and the AORTIC VALVE. Clinical signs include syphilitic aortitis, aortic insufficiency, or aortic ANEURYSM.

Solitary lesions of bone that typically cause a bulging of the overlying cortex bearing some resemblance to the saccular protrusion of the aortic wall in aortic aneurysm, hence the name. (Dorland, 27th ed)

More From BioPortfolio on "Fusion of CT Angiography With 3D Contrast Ultrasound as a Method for Follow up for Endovascular Aneurysm Repair"

Quick Search

Relevant Topics

Vascular
Vascular relates to blood vessels (Oxford Medical Dictionary) and can be used to describe the supply of blood, a disease affecting the blood vessels or molecules associated with these structures. For example, <!--LGfEGNT2Lhm-->atherosclerosis ...

Radiology
Radiology is the branch of medicine that studies imaging of the body; X-ray (basic, angiography, barium swallows), ultrasound, MRI, CT and PET. These imaging techniques can be used to diagnose, but also to treat a range of conditions, by allowing visuali...

Blood
Blood is a specialized bodily fluid that delivers necessary substances to the body's cells (in animals) – such as nutrients and oxygen – and transports waste products away from those same cells.  In vertebrates, it is composed of blo...


Searches Linking to this Trial