Pages 2001.

Clinical features and settings	People with infrarenal AAA who received EVAR. In 41 of these participants (21.6%), anatomical findings were compatible with stent‐graft placement. Type of stents received: not reported. Aneurysm diameter: mean (± SD) preoperative aneurysmal diameter determined by CT scan: 55 ± 9 mm; range: 40‐90 mm. Proximal neck of aneurysm located below renal arteries in all cases. Maximum proximal neck diameter 28 mm and minimal length 15 mm. Setting: unclear (department of surgery or department of radiology).
Participants	41 participants; 39 men; mean age: 71 years; range: 50‐83 years. Comorbidities: not reported. Geography: France.
Study design	Prospectively consecutively enrolled study. Whole sample of participants who received stent considered. Recruitment period: November 1996 to September 1999.
Target condition and reference standard(s)	Target condition: endoleak. Definition of endoleak: persistent blood flow or uptake of contrast between the stem graft and walls of the aneurysmal sac. On CT scans, endoleaks characterized by extravasation of contrast dye between prosthesis and aneurysmal wall. On CDUS, characteristic feature was detection of a colour and spectral signal outside the limits of the prosthesis. Primary endoleaks: when detected during first 30 days after endografting. Secondary endoleak: when detected after 30 days. Type I endoleaks: resulting from leakage around proximal or distal neck of stent, through stent wall, or at junctions between modular stems. Type II endoleaks: resulting from recirculation in aneurysmal sac supplied by collateral vessels from lumbar arteries or inferior mesenteric artery or both. Endoleak (absolute n): 17. Prevalence of endoleak: 26.6% (29/109). Reference standard: spiral CT scan. Image acquisition: 3 consecutive spiral CT scan acquisitions. |First scan without contrast dye with a section thickness of 10 mm to locate SMA and hypogastric arteries. Next aorta visualized from the SMA to hypogastric arteries using 2 adjoining spiral CT scans after injection of contrast dye; thickness. Type of CT scanner: Somatom Plus S system (Siemens, Erlongen, Germany). Use of contrast: not reported.
Index and comparator tests	Index test: CDUS. Image production: abdominal aorta visualized from celiac trunk to hypogastric arteries first in transverse plane and then in longitudinal plane in B‐mode and colour Doppler mode. Continuous spectral analysis performed if colour Doppler findings suggested presence of an endoleak. Type of US: 3.5‐MHz curved array transducer, Apogee 800PLUS ultrasound system (ATL, Philips, Eindhoven, the Netherlands). Use of contrast: no. Operator: 3 qualified angiologists.
Follow‐up	No loss to follow‐up, missing data, or adverse events. Uninterpretable data reported.
Notes	Postoperative surveillance included plain abdominal roentgenography, CT scan, and CDUS. Procedures performed prior to discharge and at 3, 6, 12, 24, and 30 months.
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Yes	Participants represented average patients who after receiving EVAR are exposed to endoleak surveillance.
Acceptable reference standard? All tests	Yes	Reference standard was CT scan.
Acceptable delay between tests? All tests	Unclear	Not reported.
Partial verification avoided? All tests	Yes	All study participants accounted for and results of reference standard reported for all.
Differential verification avoided? All tests	Yes	All participants who received index test subjected to same reference standard.
Incorporation avoided? All tests	Yes	Index test not part of reference standard.
Reference standard results blinded? All tests	Yes	CT scan and CDUS examination performed by different operators at different locations. Second operator had no knowledge of results of first examination. CT scans and videotaped CDUS procedures reviewed by independent radiologist.
Index test results blinded? All tests	Yes	CT scan and CDUS examination performed by different operators at different locations. Second operator had no knowledge of results of first examination. CT scans and videotaped CDUS procedures reviewed by independent radiologist.
Relevant clinical information? All tests	Yes	Yes.
Uninterpretable results reported? All tests	Yes	"In six cases, B‐mode images were uninterpretable because of the presence of intestinal gas. In 55 cases, spectral study was necessary to confirm or deny suspicion of an endoleak based on colour Doppler findings."
Withdrawals explained? All tests	Yes	No apparent dropouts observed.