Differences in Aortic Diameter Measurements with Intravascular Ultrasound and Computed Tomography After Blunt...

Area of Science:

• Vascular Surgery
• Medical Imaging
• Trauma Care

Background:

• Thoracic endovascular aortic repair (TEVAR) is standard for blunt aortic injury.
• Computed tomography (CT) may inaccurately measure aortic diameter in trauma patients.
• Intravascular ultrasound (IVUS) is recommended to complement CT for accurate aortic measurements.

Purpose of the Study:

• To investigate discrepancies between CT and IVUS measurements of aortic diameter in trauma patients.
• To determine if these measurement differences impact graft size selection for TEVAR.

Main Methods:

• Retrospective review of 16 patients undergoing TEVAR for blunt aortic injury (June 2011-2016).
• Exclusion of cases lacking complete CT and IVUS imaging or where IVUS was not used.
• Three-dimensional reconstructions used to measure aortic centerline diameters; IVUS measurements excluded aortic wall thickness.

Main Results:

• In 11 of 16 patients, IVUS and CT measurements resulted in different graft size estimates for TEVAR.
• IVUS indicated a larger graft size in 10 cases and a smaller size in 1 case compared to CT.
• Graft size selection in discordant cases correlated more with CT than IVUS measurements.

Conclusions:

• Preoperative CT scans frequently underestimate aortic diameter compared to intraoperative IVUS.
• Discrepancies in aortic diameter measurements between CT and IVUS can influence TEVAR graft selection.
• Further long-term studies are needed to assess the implications of potential endograft oversizing in young trauma patients.