Background/Aim: The role of contrast-enhanced ultrasound (CEUS) in follow-up after endovascular repair of abdominal aortic aneurysm is well established. The aim of this systematic review was to evaluate the role of CEUS after open and endovascular repair of popliteal artery aneurysm (PAA). Patients and Methods: A systematic literature review was conducted using PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.Gov, and ICTRP databases up to 2024, focusing on CEUS-based follow-up examination. The primary endpoint focused on the comparative diagnostic accuracy of CEUS for endoleaks detection after PAA repair. Results: Two studies on endoleak detection after PAA repair using CEUS were identified. Both lacked a systematic comparison of CEUS with a reference standard such as computed tomography angiography. While the overall risk of bias in patient selection and CEUS-(index) testing was considered low, the accuracy of CEUS was only assessed to a very limited extent using the established QUADAS-2 tool for diagnostic studies. In one of the two studies, CEUS was highly sensitive in detecting endoleaks, which were also detectable in PAA sac shrinkage. Conclusion: The role of CEUS in the detection of endoleaks after PAA repair is currently unclear. It can be hypothesized that CEUS-based endoleak detection is very sensitive but may not be predictive of PAA growth after repair. Future studies with improved methodological quality are necessary to define the diagnostic accuracy of CEUS-based endoleak detection and its clinical significance.
Keller et al. (Fri,) studied this question.