Computed tomography angiography provides 92% sensitivity for endoleaks, while magnetic resonance imaging detects twice as many, and contrast-enhanced ultrasonography achieves 98% sensitivity.
What are the diagnostic modalities suitable for monitoring patients after endovascular aortic repair?
While computed tomography angiography remains the reference standard for post-EVAR surveillance, MRI and contrast-enhanced duplex ultrasonography offer viable alternatives with high sensitivity and no radiation exposure.
Introduction: Abdominal aortic aneurysm is a life-threatening condition with mortality rates exceeding 80% following rupture. Risk factors for aneurysm development include advanced age, tobacco smoking history, male sex, family history, cardiovascular disease, and hypertension. Two primary treatment modalities exist: open surgical repair and endovascular aortic repair. The latter aims to exclude the aneurysmal sac from circulation through endograft placement. Given the lower complication rates associated with endovascular aortic repair compared with open surgery, the endovascular approach is the preferred treatment in selected patients. Endoleaks are the most common complication after endovascular aortic repair and necessitate lifelong surveillance. This review aims to present diagnostic modalities suitable for monitoring patients after endovascular aortic repair. Materials and methods: A literature search was conducted across electronic databases from January 2024 to May 2025 using a combination of keywords and Boolean operators. Discussion: While computed tomography angiography remains the reference standard for monitoring after endovascular aortic repair, with 92% sensitivity for endoleak detection, magnetic resonance imaging and ultrasonography offer viable alternatives that eliminate radiation exposure and may reduce contrast agent requirements. Magnetic resonance imaging detects twice as many endoleaks as computed tomography angiography, whereas contrast-enhanced duplex ultrasonography achieves 98% sensitivity and 88% specificity. Conclusion: Treatment of abdominal aorta aneurysm with endovascular aortic repair offers a significant opportunity for a carefully selected patient population. The selection of surveillance modalities should be tailored to individual patient characteristics.
Jakimów et al. (2026) conducted a review in Abdominal aortic aneurysm post-endovascular aortic repair. Radiological surveillance modalities (CTA, MRI, US) was evaluated. Computed tomography angiography provides 92% sensitivity for endoleaks, while magnetic resonance imaging detects twice as many, and contrast-enhanced ultrasonography achieves 98% sensitivity.