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Comparison of Superb Micro-Vascular Ultrasound Imaging (SMI) and Contrast-Enhanced Ultrasound (CEUS) for Detection of Endoleaks After Endovascular Aneurysm Repair (EVAR)

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)

Marcin Gabriel, Jolanta Tomczak, Magdalena Snoch-Ziółkiewicz, Łukasz Dzieciuchowicz, Ewa Strauss, Grzegorz Oszkinis

Poland Department of General and Vascular Surgery, Poznań University of Medical Sciences, Poznań, Poland

Am J Case Rep 2016; 17:43-46

DOI: 10.12659/AJCR.895415

Available online:

Published: 2016-01-25

BACKGROUND: High-resolution contrast-enhanced ultrasound is one of methods used in the detection and characterization of endoleaks, which is a frequent complication after EVAR. A new technology provided by Toshiba’s AplioTM 500 ultrasound system, called Superb Micro-Vascular Imaging (SMI), is dedicated specifically to imaging very low flow states and appears to be a promising new method for detection of endoleaks.
CASE REPORT: After endovascular treatment, a 68-year-old patient who had stent-graft implantation underwent clinical examinations, including contrast-enhanced ultrasound (CEUS), superb micro-vascular imaging (SMI), and computed tomographic angiography (CTA), revealing additional information about abnormal blood flow localized in the periphery of the sack of the left common iliac artery aneurysm. By using CEUS and SMI, the endoleak was clearly visible.
CONCLUSIONS: This case report illustrates the potential clinical value of this advanced Doppler technology (SMI) and how it could influence clinical management.

Keywords: Endoleak - ultrasonography, Contrast Media, endovascular procedures, Iliac Aneurysm - ultrasonography, Phospholipids, Sulfur Hexafluoride, Ultrasonography, Doppler, Color - methods