Valor diagnóstico de la ecografía Doppler color en el control clínico de la reparación endovascular de los aneurismas de aorta abdominal

Información del artículo

Resumen

Introducción

El control clínico del tratamiento endovascular de la enfermedad aneurismática de la aorta abdominal se basa en la valoración de la evolución del tamaño del aneurisma, la permeabilidad de la endoprótesis y la detección de fugas.

Objetivo

Comparar la ecografía Doppler (ED) color con la tomografía axial computarizada (TAC) en la evaluación del tamaño del aneurisma y la detección de fugas en el tratamiento endovascular de aneurismas de aorta abdominal.

Pacientes y métodos

Estudio prospectivo entre enero y diciembre de 2005. En 14 pacientes sometidos a tratamiento endovascular se realizó ED color y TAC a 1, 6 y 12 meses. Se compararon los tamaños del aneurisma mediante la prueba t para muestras dependientes y estudio de correlación. Sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo y el coeficiente de concordancia kappa se calcularon para la detección de fugas.

Resultados

El control clínico medio fue de 9,4 meses y se compararon 49 exploraciones. El diámetro medio del aneurisma a los tres meses de control clínico fue de 51,2cm con ED color y de 52,5cm con TAC (p = no significativo). El coeficiente de correlación ascendió a 0,97 (p < 0,001). Todos los dispositivos se mantuvieron permeables. En detección de fugas, el estudio ED color obtuvo una sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de 75, 61, 20 y 95%, respectivamente (kappa = 0,61).

Conclusiones

El estudio ED color obtiene una excelente correlación con la TAC en la medida del tamaño de los aneurismas. En cambio, posee un valor predictivo positivo muy bajo para la detección de fugas.

Palabras clave:

Aneurisma de aorta abdominal

Endofuga

Tomografía computarizada

Tratamiento endovascular

Ultrasonografía Doppler color

Summary

Introduction

Clinical monitoring of the endovascular treatment of aneurysmal disease of the abdominal aorta is based on evaluating the progression of the size of the aneurysm, the patency of the stent and the detection of leaks.

Aim

To compare colour Doppler ultrasonography (DU) with computerised axial tomography (CAT) for evaluating the size of the aneurysm and the detection of leaks in the endovascular treatment of abdominal aortic aneurysms.

Patients and methods

A prospective study between January and December 2005; colour DU and CAT scans were conducted in 14 patients submitted to endovascular treatment at 1, 6 and 12months. Sizes of the aneurysms were compared by means of the t test for dependent samples and correlation studies. Sensitivity, specificity, predictive positive value and predictive negative value and the kappa coefficient of agreement were calculated for leak detection.

Results

The mean period of clinical monitoring was 9.4months and 49 examinations were compared. The mean diameter of the aneurysm at three months’clinical monitoring was 51.2cm with colour DU and 52.5cm with CAT scanning (p = non-significant). The correlation coefficient was 0.97 (p < 0.001). Patency was maintained in all the devices. In the detection of leaks, the results of the colour DU study for sensitivity, specificity, predictive positive value and predictive negative value were 75, 61, 20 and 95%, respectively (kappa = 0.61).

Conclusions

The colour DU study correlates very well with CAT in the measurement of the size of aneurysms. In contrast, it has a very low predictive positive value for the detection of leaks.

Key words:

Abdominal aortic aneurysm

Colour Doppler ultrasonography

Computerised tomography

Endoleak

Endovascular treatment

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