Reducing Angiographic Dependence in Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms Through
Miguel Godeiro Fernandez1, Dilson Pimentel-Junior2, Guilherme Baumgardt Barbosa Lima3
1Department of Medicine, Escola Bahiana de Medicina e Sa ú de P ú blica, Salvador, Brazil.
Background:
Intravascular ultrasound (IVUS) guidance during endovascular aortic aneurysm repair (EVAR) offers potential advantages in improving technical outcomes. This study aimed to perform a meta-analysis comparing IVUS-guided to conventional angiography-assisted EVAR for infrarenal abdominal aortic aneurysms (AAAs).
Methods:
A systematic search of MEDLINE, Embase, and Cochrane databases was conducted from inception through February 2026. Eligible studies included original research comparing IVUS-guided with angiography-assisted EVAR for AAAs. A random-effects meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, while continuous variables were analyzed using mean differences (MDs) with 95% CI.
Results:
Six cohort studies involving 577 patients were included, with 248 patients (43%) undergoing IVUS-guided repair. Baseline characteristics were comparable across studies. Primary technical success was achieved in 99.8% of IVUS-assisted EVAR procedures. IVUS-guided procedures required significantly less iodine contrast (MD: -53.57 mL; 95% CI: -61.39 to -45.75; P < 0.00001), had shorter fluoroscopy times (MD: -10.89 min; 95% CI: -15.20 to -6.58; P < 0.00001), had similar operative times (MD: 4.13 min; 95% CI: -17.65 to 25.92; P = 0.71), and demonstrated inferior patient radiation (radiation dose in milligray) exposure (MD: -418.58 milligray (mGy); 95% CI: -609.53 to -227.62; P < 0.0001). The rate of early endoleaks was similar between IVUS-guided (5.9%) and angiography-assisted (5.6%) EVAR (OR: 1.02; 95% CI: 0.46 to 2.26; P = 0.95).
Conclusion:
IVUS-guided EVAR for AAAs is associated with reduced iodine contrast use, decreased fluoroscopy time, and reduced patient radiation exposure.
