Contrast-enhanced ultrasound performed under urgent conditions. Indications, review of the technique, clinical examples and limitations

Contrast-enhanced ultrasound (CEUS) is an imaging technique with various indications, most of which refer to scheduled examinations. However, CEUS can also be performed under urgent conditions for the investigation of many different clinical questions. This article reviews basic physics of ultrasound contrast agents and examines the commonest urgent clinical applications of CEUS. These include, among others, abdominal solid organ trauma and infarcts, scrotal and penile pathology and blood vessel imaging. Patients can be examined with a very short time delay at their bedside, without exposure to ionising radiation or risk of anaphylactic reaction and renal failure, while contraindications are minimal. CEUS technique is described for various urgent indications and imaging examples from our department’s experience are presented. Safety matters and limitations of CEUS are also mentioned. Teaching Points Contrast-enhanced ultrasound (CEUS) can be performed urgently for various clinical applications. Abdominal indications include solid organ trauma and infarcts. CEUS in abdominal organ trauma correlates well with CT and can replace it for patient follow-up. CEUS images testicular torsion, infection and infarction, as well as testicular and penile trauma. Blood vessels can be assessed with CEUS for obstruction, aneurysm, thrombosis and dissection

Aortic rupture during endovascular repair of a postoperative coarctation pseudoaneurysm in an adult: Emergency lifesaving stent graft implantation

We present a case with aortic rupture during an operation of thoracic endovascular aortic repair of an anastomotic pseudoaneurysm. This happened after the use of a low-pressure remodeling balloon inside the covered part of the deployed endografts. It was successfully treated with a second more centrally in the aortic arch-implanted endograft with full coverage of the left subclavian artery orifice. This patient had a history of surgically operated aortic coarctation

A multicenter \u201creal-world\u201d study of the valiant NAVION stent graft

Background: The aim of the present study was to evaluate early results of thoracic endovascular aortic repair (TEVAR) using the Valiant NavionTM stent graft in a \u201creal-world\u201d scenario. Methods: All patients who underwent TEVAR with the Valiant NavionTM endograft between November 2018 and November 2019 were included in this retrospective multicenter study (six European centers). The primary end- points were technical success, incidence of major adverse events (MAEs), access failure, deployment failure, de- ployment accuracy, and rate of intraoperative endoleaks (ELs). Results: One hundred-sixteen patients with varying thoracic aortic diseases were included. Eighteen patients (15.5%) were treated for an off-label condition. The technical success rate was 100%, without any access or de- ployment failures. The proximal and distal deployment accuracy rates were 99.1% and 97.4%, respectively. There were no intraoperative MAEs, including death. Two (1.7%) type Ib ELs were detected at the first postoper- ative CTA, all of which were in off-label procedures and related to the short length of the sealing neck. No type III ELs were detected. The median hospitalization time was 8 days (IQR 4\u201312), including a median intensive care unit stay of 1 day (IQR 1\u20132). The in-hospital mortality rate was 4.3%. At a median follow-up time of 98 days (IQR 39\u2013187), there were no aortic-related mortalities or new onset of endoleaks. Conclusion: Our initial experience with the Valiant NavionTM endograft in a wide variety of aortic diseases showed safe early outcomes, especially for on-label procedures