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We have evaluated the efficacy of duplex ultrasound (US) harmonic imaging with the addition of an ultrasound contrast agent in the post-operative evaluation of aortic aneurysm repair. Duplex ultrasound evaluation was done while the contrast was circulating throughout the blood pool, using digitally coded transmit-receive ultrasound pulse sequences with tissue harmonic imaging to optimize visualization. Twenty patients were evaluated, eighteen with modular stent grafts and two with unibody bifurcated stent grafts. All stent grafts remained widely patent with normal aorto-iliac flow hemodynamics. Duplex ultrasound with contrast identified all eight of the endoleaks seen by computed tomography angiography. In two patients ultrasound with contrast detected small endoleaks not seen by CTA, but confirmed by angiography at the time of endovascular closure. Standard duplex ultrasound failed to identify four of the ten endoleaks. Duplex ultrasound, when used with an ultrasound contrast agent in the follow-up of aortic aneurysm repair, appears to provide very good sensitivity to patency and the presence and type of any endoleaks present.