Objective: Angiography is the traditional tool used for the peroperative work-up in endovascular aneurysm repair. Alternatively, IntraVascular UltraSound (IVUS) can be used. IVUS generates high definition circumferential cross sectional images and provides real time read out of vascular dimensions and detailed vessel wall analysis including visualization of vessel branches. We present our experience using IVUS for thoracic aortic aneurysm repair.
Methods: Out of consecutive 203 patients with descending thoracic aortic aneurysm (TAA) repair, 89 (43.8%) received endovascular treatment (median age 68, range 29-82, male 79 (88.7%) female 10 (11.3%)) without perprocedural angiography. IVUS (6 F, 12.5 MHz probe or 10F 9 MHz ) coupled with fluoroscopy for the placement of radiopaque markers was used for target site identification, landing zone measurement, device positioning, and assessment of endovascular repair.
Results: Hospital mortality was 4/89 (4.5%). Mean number of devices implanted in each patient was 1.2 (range 1 to 3). Median X-ray exposure time was 12 min (range 8 - 35). Median procedure time was 63 min (range 55-300). Conversion to open surgery was necessary in one patient (1.1%) due to perprocedural aortic dissection. In 9 patients (10.1%) left subclavian artery was intentionally covered because of a short neck. One patient (1.1%) who had left subclavian artery and left carotid artery intentionally covered with the endoprosthesis, had previously received carotid artery cross over bypass. 2 patients (2.2%) had lesions of the ilio femoral access during the insertion of the prosthesis and required surgical repair. One patient developed paraplegia (1.1%). None developed renal failure. Early endoleak (at discharge) were observed in 8 patients (8.9%) and 4 (4.5%) required additional procedures (proximal or distal extensions). Late conversion was necessary in one patient (1.1%) for distal progression.
Conclusions: IVUS provides all information necessary for device selection, target site identification as well as safe and correct deployment of thoracic endoprostheses. It is a user friendly and a reliable tool for TEVAR and makes perprocedural angiography unnecessary, thus avoiding the risk of renal failure due to contrast medium. The IVUS control and IVUS catheter are all operated by the surgeon in charge. No additional personnel is necessary.