How Helpful Is Intravascular Ultrasonography In Thoracic Endovascular Aortic Repair?
Antonio Mariniello1, Ettorino Di Tommaso1, Giuseppe Comentale1, Alessandro Saccenti2, Luigi Di Tommaso1, Gabriele Iannelli1.
1Department of Cardiac Surgery A.O.U. Federico II, Napoli, Italy, 2Department of Anesthesiology A.O.U. Federico II, Napoli, Italy.
Objective: Appropriate treatment of aortic pathologies depends on the accurate visualization of the aorta. Intravascular ultrasonography (IVUS) is an emerging aortic imaging technique used during thoracic endovascular aortic repair (TEVAR). IVUS provides immediate and dynamic imaging of aortic pathology contributing to the choice of the diameter of the endoprothesis, it allows to determine the size, origin and patency of epiaortic and visceral vessels and reduce the times of exposure to radiation and the amount of contrast administered. In order to evaluate usefulness, limitation and accuracy of aortic parameters, IVUS was compared with, transesophageal echocardiography in an experimental phase on pigs and with CT scan and contrast angiography in a clinical trial on patients undergone TEVAR .
Methods: IVUS was compared with transesophageal echocardiography (TEE) in pigs undergone TEVAR for testing a new stent-graft, to asses the accuracy of measurements of the aortic diameter and branch-vessels position. We also compared IVUS with CT scan and conventional angiography, in patients undergone TEVAR for type B aortic dissection, to assess the accuracy to define aortic and iliac diameters, length of the proximal and distal landing zone and to confirm branch-vessels position reducing contrast load when compared with contrast angiography imaging.
Results: There was a precise correspondence between the aortic measurements made with IVUS compared with those made with transesophageal echocardiography. IVUS showed a better intraoperative imaging compared TEE for precise identification of epiaortic vessels, celiac axis and vascular access. In patients with Type B aortic dissection we precisely identify the site of the intimal tear and its relationship with supraaortic vessels. In one patient we could detected and treat a stent infolding of an overlapping endograft misleaded by contrast angiography.
Conclusions: IVUS allows for precise identification of critical vessel origins compared with other imaging technique and reducing more angiographic views.
With IVUS can limit radiation and contrast exposure from both preoperative CT scans and intraoperative angiography and many procedures can be performed with limited or no use of iodinated contrast agents in patients with renal failure, a suspected allergy to contrast agents or anatomical difficulties.
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