Affiliation:
1. Vascular Surgery Department, Civic Hospital of Palermo, Palermo, Italy
Abstract
Arteriography with contrast medium (CM) injection is normally employed to visualise the lowest renal artery during endovascular aneurysm repair (EVAR). Intravascular ultrasound (IVUS) has been proposed as an alternative, real-time imaging diagnostic technique to arteriography. In this study, we evaluated the feasibility of EVAR using Anaconda repositionable aortic stent graft (Vascutek) assisted by IVUS (Volcano Visions, Philips) during intraluminal navigation without CM. From January 2016 to December 2017, 25 patients with infrarenal abdominal aortic aneurysms, identified through anatomical inclusion criteria, underwent EVAR. All of the patients had an arteriogram at the end of the EVAR procedure to confirm aortic stent graft patency and to exclude type 1 endoleaks. The primary objective was the technical and clinical success of this CM-free aortic stent graft delivery procedure. At the end of the period, 150 target vessels were evaluated. IVUS versus angio-CT sensitivity and specificity rate were 97.3% and 100%, respectively. The primary technical success was obtained in 88% of the cases. Three patients (12%) needed CM injection to complete the procedure and there were no cases of type 1 endoleak. Primary clinical success was 100%. During follow-up at a mean of 20 months, none of the patients died or had complications. We conclude that a full EVAR procedure is feasible using only IVUS navigation and repositionable aortic stent graft without CM injection in anatomically selected cases.
Reference24 articles.
1. 1. Mani K, Lees T, Beiles B, et al. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report. Eur J Vasc Endovasc Surg 2011;42:598-607. https://doi.org/10.1016/ j.ejvs.2011.06.043; PMID: 21775173.
2. 2. Nguyen BN, Neville RF, Rahbar R, et al. Comparison of outcomes for open abdominal aortic aneurysm repair and endovascular repair in patients with chronic renal insufficiency. Ann Surg 2013;258:3949. https://doi.org/10.1097/ SLA.0b013e3182a15ada; PMID: 24022432.
3. 3. Rödel SGJ, Geelkerken RH, Prescott RJ, et al. The Anaconda AAA stent graft: 2-year clinical and technical results of a multicentre clinical evaluation. Eur J Vasc Endovasc Surg 2009;38:732-40. https://doi.org/10.1016/j.ejvs.2009.08.007; PMID: 19775918.
4. 4. Ohki T. Pros and cons of IVUS imaging for endovascular procedures. Endovascular Today 2008;3:80-2. Available at: https://evtoday.com/2008/03/EVT0308_12.php (accessed 15 February 2019).
5. 5. Clark DJ, Lessio S, O'Donoghue M, et al. Safety and utility of intravascular ultrasound-guided carotid artery stenting. Cathet Cardiovasc Interv 2004;63:355-62. https://doi.org/10.1002/ ccd.20188; PMID: 15505835.