Keschenau PR, et al. - Via performing this pilot study, researchers evaluated intraoperative contrast-enhanced ultrasound (iCEUS) examination for its ability to detect endoleak (EL) after complex endovascular aortic repairs (EVAR) relative to the standard angiographic completion control. Among 21 included patients (16 male; median age, 73 years [range, 54-81 years]) who underwent single-stage EVARs, 14 underwent fenestrated and/or branched EVAR, five underwent infrarenal EVAR, one underwent infrarenal EVAR with bilateral iliac side branch implantation, and one underwent infrarenal EVAR with occluder implantation into the internal iliac artery. An angiographic completion control was performed on all patients for EL detection; this was followed by iCEUS examination. Eight type II EL were identified with angiography, defining the EL origin in four cases. iCEUS examination detected all of these eight EL; in addition, it identified further eight type II EL that were not seen on angiography and allowed a definition of the EL origin in all cases. Findings support the utility of an iCEUS examination as another adjunct to reduce exposure to contrast agent and radiation during EVAR, including complex procedures. For infrarenal EVAR as well as for endovascular type IV or type V repairs, a replacement of the completion angiography by iCEUS examination is conceivable.