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To compare aortic sac changes after endovascular aneurysm repair (EVAR) assessed by three-dimensional ultrasound (3D-US), two-dimensional ultrasound (2D-US), and traditional computed tomographic angiography (CTA).Using volume assessment with three-dimensional CTA (3D-CTA-volume) as the gold standard, this study investigated aortic sac changes at three and 12 months after EVAR with three different ultrasound methods (2D-US anterior-posterior (AP) diameter, 3D-US AP centerline diameter, and 3D-US partial volume), and traditional CT multiplanar outer-to-outer diameter (CT-MPR OTO diameter). From august 1st, 2011 to January 2014, consecutive EVAR patients (n = 113) were available for analysis in two time intervals; 1) between preoperative and three-month follow-up and 2) between three and 12 month follow-up.The risk of missing true aortic sac growth (false negative finding) at three-month postoperative visit using 3D-US partial volume, 3D-US AP centerline diameter, 2D-US AP diameter, and CT-MPR OTO diameter was 19%, 21%, 22%, and 18%, respectively. Corresponding low sensitivities (0% to 21%) and kappa-values (0.50) in detecting aortic sac changes were found. The risk of missing true growth between three and 12 months were lower (6%, 5%, 6%, and 6%, respectively), and matching sensitivities 33%, 33%, 17%, and 17%, respectively.All tested methods for aortic sac changes were as good as traditional CT-MPR OTO diameter and corresponded poorly with 3D-CTA-volume at three months postoperative visit but substantially better after 12 months where the residual sac change was more profound.

To compare the risk of gluteal claudication after endovascular aneurysm repair (EVAR) of aortoiliac aneurysms by interventional exclusion of the internal iliac artery (IIA) with plugs or coils versus a branch iliac device to maintain pelvic blood supply and to identify risk factors for postoperative gluteal claudication.A retrospective analysis of a prospectively collected data set included patients with aortoiliac aneurysms treated with EVAR from January 2007 to December 2013 at a tertiary referral vascular unit. Descriptive and procedural data were obtained from a database of prospectively enrolled patients. Medical records of 112 consecutive patients treated with EVAR were scrutinized for graft-related adverse events and pelvic ischemia. The occurrence of gluteal claudication was determined from medical records.Iliac occlusion was performed in 115 limbs, and a branch iliac device was placed in 25 limbs. Gluteal claudication developed in 38% of limbs treated with IIA exclusion but in none of the limbs treated with branch iliac devices (P.001). Procedure time, fluoroscopy time, and use of iodine contrast material did not differ between the two groups. The incidence of gluteal claudication was higher when coils rather than plugs were used for embolization of the IIA before EVAR (P = .002).The findings suggest that the use of a branch iliac device significantly reduces the risk of gluteal claudication after EVAR of aortoiliac aneurysm.

Objectives Volume estimation is more sensitive than diameter measurement for detection of aneurysm growth after endovascular aneurysm repair (EVAR), but this has only been confirmed on three-dimensional, reconstructed computer tomography (3-D CT). The potential of 3-D ultrasound (3-D US) for volume estimation in EVAR surveillance is unknown. Design Prospective validation study comparing 3-D US with 3-D CT, using 3-D CT as the gold standard. Materials and methods From August 2011 to March 2012, 93 consecutive EVAR patients were enrolled and examined with both 3-D US and CT angiography (CTA). Image data were analysed in a mutual blinded setup using a 3-D interactive segmentation technique. Results The technical success rate of 3D-US was 98% (91/93). In 91 EVAR patients (F/M; 10/81) eligible for further analysis, the mean maximum volume (SD) was 126 (58) ml using 3-D US and 128 (58) ml using 3-D CT. The mean difference was 1 ml (0.4%) and the limits of agreement were −14 to 16 ml (−11; 12%). Conclusion Volume estimation of the aortic sac after EVAR using 3-D US is a feasible and accurate method using 3-D CT as the gold standard.

Background: Aspirin is a widely used drug for prevention of thrombotic events in cardiovascular patients, but approximately 25% of patients experience insufficient platelet inhibition as a result of aspirin and remain at risk of cardiovascular events. This study aimed to investigate the value of a circulatingmicroRNA and platelet size as biomarkers of the individual response to aspirin therapy. Methods: Blood samples were collected from 50 healthy blood donors without antithrombotic medication and 50 patients with intermittent claudication on daily aspirin therapy. Based on results from the arachidonic acid stimulated aggregation test on Multiplate analyzer (ASPItest), patients were defined as aspirin resistant (n 1⁄4 10) or aspirin responders (n 1⁄4 40). Plasma levels of the specific microRNA were evaluated by RT-qPCR analysis and platelet distribution width (PDW) was used to assess platelet size variability. Receiver operating characteristic curves for the plasma level of microRNA and PDW were used to set cut-off values for discrimination between aspirin responding and aspirin resistant patients. Results: When defining aspirin resistance as an ASPItest 30 U, the optimal cut-off values for discrimination of aspirin responders and aspirin resistant patients were found to be PDW > 11.8 fL and a relative expression level of the microRNA > 4.5. Using these cutoff values we could define a PDW/microRNA-score with a specificity of 97.5% and a sensitivity of 80.0% in relation to detect aspirin resistance. The corresponding positive and negative predictive values were found to be 88.9% and 95.1%, respectively. Conclusion: Aspirin resistance can potentially be identified by microRNA levels in plasma combined with PDW. Contrast-enhanced Ultrasound Instead of CTA in EVARsurveillance Kim Kargaard Bredahl , Mikkel Taudorf , Lars Lonn , Katja Vogt , Henrik Sillesen , Jonas Eiberg a,c a Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark b Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark c University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark Abstract Introduction: In order to minimize the risk of endoleak, fracture, migration and eventually rupture after endovascular aneurysm repair, lifelong surveillance is mandatory. Computed Tomographic Angiography (CTA) is considered the standard image modality,Introduction: In order to minimize the risk of endoleak, fracture, migration and eventually rupture after endovascular aneurysm repair, lifelong surveillance is mandatory. Computed Tomographic Angiography (CTA) is considered the standard image modality, although patients are exposed to ionizing radiation and nephrotoxic contrast medium. Duplex Ultrasound (DUS) and Contrast-enhanced ultrasound (CEUS) have been suggested as alternative image modalities, and the aim of this study was to determine the diagnostic efficacy of DUS and CEUS, using CTA as the gold standard. Method: Patients who underwent EVAR for aorto-iliac aneurysm disease between August 1st 2011 and October 31st 2014 were prospectively and consecutively enrolled in a cross-sectional study. We added CEUS to our existing EVAR-surveillance protocol including DUS, plain abdominal X-ray and CTA performed at 3and 12 months after stent implantation. Results: Endoleaks were depicted by CTA in 66 (24%) cases out of 278 included patients. The sensitivity of CEUS was significantly better than the sensitivity of DUS, 88% (95%-CI: 80e96) and 47% (95%-CI: 35e59) (p < 0.001), respectively. Endoleak detection by CTA led to re-intervention in 11 (4%) cases, of which all were depicted by CEUS, but 3 were missed by DUS. Conclusion: In general, CTA can be replaced by CEUS in EVARsurveillance programs, although DUS may suffice in uncomplicated cases if preceded by a normal CEUS or CTA. Aortocaval Fistula (ACF) in Patients Operated for Ruptured Acute Aorta Aneurysm (rAAA): A Surgical Challenge Karina Warning, Kim Houlind, Hans Ravn Department of Vascular Surgery, Lillebaelt Hospital, Skovvangen 2-8, 6000