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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2001 Dicembre;42(6):787-92

lingua: Inglese

Limited role for IVUS in the endovascular repair of aortoiliac aneurysms

Lipsitz E. C., Ohki T., Veith F. J., Berdejo G., Suggs W. D., Wain R. A., Mehta M., Valladares J., Mckay J.

From the Divi­sion of Vas­cular Sur­gery Depart­ment of Sur­gery Mon­tef­iore Med­ical ­Center and the ­Albert Ein­stein Col­lege of Med­i­cine Bronx, NY, USA


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Back­ground. To deter­mine the ­need for rou­tine ­versus selec­tive intra­op­er­a­tive ­IVUS ­during endo­vas­cular aor­toi­liac aneu­rysm (AIA) ­repair.
­Methods. One-hun­dred and ­eighty-­eight endo­vas­cular AIA ­repairs per­formed ­over a 5-­year ­period ­were ­reviewed and ­included in the ­study. Sur­geon-­made ­aorto-uni-­femoral ­grafts (n=78) and ­industry-­made bifur­cated or ­tube ­grafts (n=110) ­were ­used. In the ­initial 51 ­cases ­IVUS was rou­tinely per­formed. In the ­latter 137 ­cases ­IVUS was ­used selec­tively. In ­this ­group ­graft defor­mities sus­pected on com­ple­tion angio­graphy or pull­back pres­sure meas­ure­ments ­were ­treated ­with bal­loon dil­a­ta­tion and ­stenting. ­IVUS was ­then per­formed ­only in the pres­ence of a per­sis­tent pres­sure gra­dient or incon­clu­sive angio­graphic find­ings.
­Results. In the ­initial 51 ­cases ­IVUS ­revealed 20 ­lesions of ­which 8 ­were not ­initially ­detected angio­graph­i­cally and ­which ­required fur­ther treat­ment. In the ­latter 137 ­cases ­IVUS was nec­es­sary in ­only 1 ­case, and ­guided the treat­ment of an angio­graph­i­cally unde­tect­able ­lesion. ­There ­have ­been no ­late epi­sodes of ­graft com­pres­sion, ­kinking, or throm­bosis in the selec­tive ­IVUS ­group.
Con­clu­sions. The use of pull­back pres­sure meas­ure­ments ­with a low ­threshold for angio­plasty and ­stenting, espe­cially in unsup­ported ­grafts, fol­lowed by the selec­tive use of ­IVUS ­decreases the ­overall require­ment for ­IVUS and its asso­ciated ­costs.

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