Int Angiol. 2026 Jun;45(3):174-180. doi: 10.23736/S0392-9590.26.05523-9.
ABSTRACT
BACKGROUND: Accurate measurement of the residual sac after endovascular aortic repair (EVAR) is essential for effective surveillance, guiding detection of complications and decisions regarding reintervention. While two-dimensional ultrasound (2D-US) remains standard-of-care, it is limited by operator variability. Three-dimensional ultrasound (3D-US) with modeling software has demonstrated improved precision but remains resource-intensive. The introduction of three-dimensional Software-Assisted Ultrasound (3D-SAUS) offers an automated, on-cart alternative for more streamlined clinical use. This study compares 3D-SAUS with 2D-US in measuring maximum residual sac diameter in EVAR patients, focusing on variability and clinical applicability.
METHODS: Patients previously treated with EVAR and following US-based follow-up were scanned by three or four experienced ultrasound operators. The maximum anterior-posterior residual sac diameter was measured for all patients using 2D-US and 3D-SAUS. Outcomes were median and limits of agreement (LoA) with 95% confidence intervals for both modalities.
RESULTS: Fourteen EVAR-treated patients underwent 44 paired 2D-US and 3D-SAUS scans. Median maximum residual sac diameters were 50.0 mm with 2D-US and 50.3 mm with 3D-SAUS. LoA were 3.4 mm for 2D-US and 3.6 mm for 3D-SAUS, with overlapping 95% confidence intervals (2.2-4.6 mm and 2.5-4.7 mm, respectively). The difference in LoA was not statistically significant (P=0.61). Automatic technical success was achieved in 79% of the available 3D scans.
CONCLUSIONS: 3D-SAUS demonstrated comparable residual sac diameter measurement precision and variability to expert 2D-US in post-EVAR patients. These findings support the potential of 3D-SAUS to enhance reproducibility and standardize ultrasound-based follow-up.
PMID:42345186 | DOI:10.23736/S0392-9590.26.05523-9
