Contrast-enhanced Ultrasound Instead of CTA in EVAR-surveillance

Background: Aspirin is a widely used drug for prevention of thrombotic events in cardiovascular patients, but approximately 25% of patients experience insufficient platelet inhibition as a result of aspirin and remain at risk of cardiovascular events. This study aimed to investigate the value of a circulatingmicroRNA and platelet size as biomarkers of the individual response to aspirin therapy. Methods: Blood samples were collected from 50 healthy blood donors without antithrombotic medication and 50 patients with intermittent claudication on daily aspirin therapy. Based on results from the arachidonic acid stimulated aggregation test on Multiplate analyzer (ASPItest), patients were defined as aspirin resistant (n 1⁄4 10) or aspirin responders (n 1⁄4 40). Plasma levels of the specific microRNA were evaluated by RT-qPCR analysis and platelet distribution width (PDW) was used to assess platelet size variability. Receiver operating characteristic curves for the plasma level of microRNA and PDW were used to set cut-off values for discrimination between aspirin responding and aspirin resistant patients. Results: When defining aspirin resistance as an ASPItest 30 U, the optimal cut-off values for discrimination of aspirin responders and aspirin resistant patients were found to be PDW u003e 11.8 fL and a relative expression level of the microRNA u003e 4.5. Using these cutoff values we could define a PDW/microRNA-score with a specificity of 97.5% and a sensitivity of 80.0% in relation to detect aspirin resistance. The corresponding positive and negative predictive values were found to be 88.9% and 95.1%, respectively. Conclusion: Aspirin resistance can potentially be identified by microRNA levels in plasma combined with PDW. Contrast-enhanced Ultrasound Instead of CTA in EVARsurveillance Kim Kargaard Bredahl , Mikkel Taudorf , Lars Lonn , Katja Vogt , Henrik Sillesen , Jonas Eiberg a,c a Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark b Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark c University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark Abstract Introduction: In order to minimize the risk of endoleak, fracture, migration and eventually rupture after endovascular aneurysm repair, lifelong surveillance is mandatory. Computed Tomographic Angiography (CTA) is considered the standard image modality,Introduction: In order to minimize the risk of endoleak, fracture, migration and eventually rupture after endovascular aneurysm repair, lifelong surveillance is mandatory. Computed Tomographic Angiography (CTA) is considered the standard image modality, although patients are exposed to ionizing radiation and nephrotoxic contrast medium. Duplex Ultrasound (DUS) and Contrast-enhanced ultrasound (CEUS) have been suggested as alternative image modalities, and the aim of this study was to determine the diagnostic efficacy of DUS and CEUS, using CTA as the gold standard. Method: Patients who underwent EVAR for aorto-iliac aneurysm disease between August 1st 2011 and October 31st 2014 were prospectively and consecutively enrolled in a cross-sectional study. We added CEUS to our existing EVAR-surveillance protocol including DUS, plain abdominal X-ray and CTA performed at 3and 12 months after stent implantation. Results: Endoleaks were depicted by CTA in 66 (24%) cases out of 278 included patients. The sensitivity of CEUS was significantly better than the sensitivity of DUS, 88% (95%-CI: 80e96) and 47% (95%-CI: 35e59) (p u003c 0.001), respectively. Endoleak detection by CTA led to re-intervention in 11 (4%) cases, of which all were depicted by CEUS, but 3 were missed by DUS. Conclusion: In general, CTA can be replaced by CEUS in EVARsurveillance programs, although DUS may suffice in uncomplicated cases if preceded by a normal CEUS or CTA. Aortocaval Fistula (ACF) in Patients Operated for Ruptured Acute Aorta Aneurysm (rAAA): A Surgical Challenge Karina Warning, Kim Houlind, Hans Ravn Department of Vascular Surgery, Lillebaelt Hospital, Skovvangen 2-8, 6000