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Computed Tomography-Aortography Versus Color-Duplex Ultrasound for Surveillance of Endovascular Abdominal Aortic Aneurysm Repair

Elixène Jean-Baptiste 1 Patrick Feugier 2 Coralie Cruzel Gabrielle Sarlon-Bartoli 3 Thierry Reix 4 Eric Steinmetz 5 Xavier Chaufour 6 Bertrand Chavent 7 Lucie Salomon Du Mont 8 Meghann Ejargue 9 Blandine Maurel 10, 11 Rafaelle Spear 12 Dominique Midy Fabien Thaveau 13 Pascal Desgranges 14 Eugenio Rosset 15 Réda Hassen-Khodja 1 Pascale Bureau Mireille Ravoux Catherine Bozzetto Marie-Antoinette Sevestre-Pietri 16 Béatrice Terriat Claire Favier Maryse Degeilh Claire Le Hello Jean-Pierre Favre Simon Rinckenbach Anca Loppinet yann Goueffic Jérôme Connault yves Alimi Pierre Barthélémy Jean-Luc Magne Christophe Seinturier Marie-Luce Choukroun Olivier Rouyer Liliane Bitton Jean-Pierre Becquemin 
Abstract : Background Color-duplex ultrasonography (DUS) could be an alternative to computed tomography-aortography (CTA) in the lifelong surveillance of patients after endovascular aneurysm repair (EVAR), but there is currently no level 1 evidence. The aim of this study was to assess the diagnostic accuracy of DUS as an alternative to CTA for the follow-up of post-EVAR patients. Methods Between December 16, 2010, and June 12, 2015, we conducted a prospective, blinded, diagnostic-accuracy study, in 15 French university hospitals where EVAR was commonly performed. Participants were followed up using both DUS and CTA in a mutually blinded setup until the end of the study or until any major aneurysm-related morphological abnormality requiring reintervention or an amendment to the follow-up policy was revealed by CTA. Database was locked on October 2, 2017. Our main outcome measures were sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of DUS against reference standard CTA. CIs are binomial 95% CI. Results This study recruited prospectively 659 post-EVAR patients of whom 539 (82%) were eligible for further analysis. Following the baseline inclusion visit, 940 additional follow-up visits were performed in the 539 patients. Major aneurysm-related morphological abnormalities were revealed by CTA in 103 patients (17.2/100 person-years [95% CI, 13.9–20.5]). DUS accurately identified 40 patients where a major aneurysm-related morphological abnormality was present (sensitivity, 39% [95% CI, 29–48]) and 403 of 436 patients with negative CTA (specificity, 92% [95% CI, 90–95]). The negative predictive value and positive predictive value of DUS were 92% (95% CI, 90–95) and 39% (95% CI, 27–50), respectively. The positive likelihood ratio was 4.87 (95% CI, 2.9–9.6). DUS sensitivity reached 73% (95% CI, 51–96) in patients requiring an effective reintervention. Conclusions DUS had an overall low sensitivity in the follow-up of patients after EVAR, but its performance improved meaningfully when the subset of patients requiring effective reinterventions was considered. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01230203.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03688719
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Soumis le : dimanche 5 juin 2022 - 20:59:09
Dernière modification le : lundi 27 juin 2022 - 03:02:25

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Elixène Jean-Baptiste, Patrick Feugier, Coralie Cruzel, Gabrielle Sarlon-Bartoli, Thierry Reix, et al.. Computed Tomography-Aortography Versus Color-Duplex Ultrasound for Surveillance of Endovascular Abdominal Aortic Aneurysm Repair. Circulation: Cardiovascular Imaging, American Heart Association, 2020, 13 (6), ⟨10.1161/CIRCIMAGING.119.009886⟩. ⟨hal-03688719⟩

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