Pre-Discharge Duplex Ultrasound Scans Detect Endoleaks Not Seen on Completion Angiography After Endovascular Aneurysm Repair

Purpose To determine whether a pre-discharge duplex ultrasound scan detects early endoleaks that would not otherwise have been identified. Methods A retrospective review was conducted of all patients undergoing elective infrarenal endovascular aneurysm repair (EVAR) at our center. These patients underwent intraoperative completion angiography, had a duplex ultrasound scan prior to hospital discharge, and were followed at 1, 3, and 6 months and at 6-month intervals thereafter. The outcome of any patients found to have an endoleak on a pre-discharge scan was studied. Results There were 52 EVAR patients (50 men; mean age 76 years, range 61-87) with endoleak on the pre-discharge duplex: 17 (2.8%) type I, 28 (4.6%) type II, and 8 (1.3%) type III. Of these, only 7 of the type I and 2 of the type II leaks had been detected on completion angiography. Among the patients with type I endoleaks, 5 had resolution of the leak, 10 required further endovascular interventions, and 2 had open repair (1 died of aneurysm rupture). Two patients with failed endovascular repairs of the leak also had open repair. Fifteen of the 28 type II endoleaks resolved, 4 were treated with endovascular procedures, 1 had open repair, 7 are being observed, and 1 was lost to follow-up. Six of the 8 type III leaks resolved, 1 required open repair for an enlarging sac, and 1 is being observed. Conclusion Despite routine completion angiography, new endoleaks may be identified postoperatively, which suggests that more rigorous imaging at the point of completion angiography is required.