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Intravascular ultrasound in endovascular stent-grafts for peripheral aneurysm: a clinical study
M R van Sambeek1, E J Gussenhoven, H van Overhagen
1Department of Vascular Surgery, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands. vansambeek@hlkd.azr.nl
Purpose:
To evaluate the potential diagnostic information of intraprocedural intravascular ultrasound (IVUS) in patients undergoing endovascular stent-grafting for peripheral aneurysm.
Methods:
IVUS was used in 17 patients preprocedurally to measure the diameter of the proximal and distal neck and the length of the aneurysm. Balloon and stent-graft sizes were selected based on these measurements. Following stent-graft deployment, angiography and IVUS were used to document stent apposition and the configuration and diameter of the stent-graft.
Results:
Stent-graft insertion was considered successful in 8 patients based on angiography and IVUS images. In 9 others, both imaging modalities showed inadequate results, necessitating 12 additional procedures: balloon angioplasty for stent-graft stenosis (2) and inadequate stent-graft apposition (1); an additional stent-graft (4); an extra stent (1); thrombectomy (2); and conversion (2) for inadequate stent-graft position and a graft rupture. In these patients, intraprocedural IVUS was superiorto angiography in contributing vital information to aid in the selection of the additional interventions.
Conclusions:
During management of peripheral aneurysms with endovascular stent-grafts, IVUS monitoring was a useful adjunct when the initial procedure was unsatisfactory and/ or when intraprocedural angiographic studies were inconclusive.