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 Pietri-Sevestre (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

1 C3M - Centre méditerranéen de médecine moléculaire
2 Département de chirurgie vasculaire
3 TIMONE - Hôpital de la Timone [CHU - APHM]
4 CHU Amiens-Picardie
5 CHU Dijon
6 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
7 SAINBIOSE - Santé Ingénierie Biologie Saint-Etienne
8 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
9 AMU SMPM MED - Aix-Marseille Université - École de médecine
10 Physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives
11 CHU Pitié-Salpêtrière [AP-HP]
12 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
13 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
14 IMRB - Institut Mondor de Recherche Biomédicale
15 Service de Chirurgie Thoracique Vasculaire [CHU Clermont-Ferrand]
16 CHIMERE - CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516

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.

Domaines: Sciences du Vivant [q-bio]

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, 2020, 13 (6), ⟨10.1161/CIRCIMAGING.119.009886⟩. ⟨hal-03688719⟩