Role of Color Duplex Ultrasound for Aortic Endografts

The advent of minimally invasive endovascularr techniques in the treatment of AAAs (EVAR) has increased the need for repeat imaging especially in the postoperative period. While computed tomography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, color duplex ultrasound (CDU) technology has significantly evolved over the past decade and has become the cornerstone for surveillance post EVAR at multiple institutions. In addition to standard CDU, contrast-enhanced ultrasound modalities are revolutionizing AAA postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly it can detect endoleaks post EVAR with high sensitivity and specificity. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. The purpose of this chapter is to examine the use of CDU in aortic endografts and present the evidence supporting a selective policy of EVAR followup with duplex scanning.