Intravascular ultrasound (IVUS) has been introduced as diagnostic adjunct to provide new insights in the diagnosis and therapy of vascular disease. Herein we compared the outcomes of conventional endovascular aneurysm repair (EVAR) and EVAR with IVUS in patients presenting infrarenal abdominal aortic aneurysm using a propensity-matched cohort. Methods From May 2013 to August 2017, 221 patients were retrospectively analysed. 122 patients were eligible for inclusion and underwent to propensity score matching. Perioperative mortality and morbidity, renal function impairment, endoleak incidence, mean contrast medium usage, operative time, radiation exposure [including fluoroscopy time, dose-area product (DAP) and digital subtraction angiography (DSA) runs] , survival and freedom from reintervention were the outcomes measured. Results After matching, 52 patients were included, 26 in the conventional EVAR group and 26 in the EVAR with IVUS group. No perioperative mortality or type I/III endoleak were registered. One perioperative lymphatic fistula and one iliac limb occlusion were observed. In the EVAR with IVUS group, a significant reduction of contrast medium (92[vs51±17] vs 51[20-68] ml; P=.003) and radiation exposure including fluoroscopy time (12 [9-16] vs 20 [12-25] minutes; P=.001); DAP (15 [9-21] vs 32 [16-44] G*cm 2 ; P=.002); DSA runs (2 [1-3] vs 3 [2-4]; P=.04)was reported. No differences were observed in term of glomerular filtration rate (86[45-121] vs 90[38-117] ml/min; P=.14) and operation time (176[124-210] vs179[120-210]; P=.48). Survival at 36 months was 93% for standard EVAR and 92% for EVAR with IVUS (P=.845). Freedom from reintervention at 36 months was 85.5% in both groups (P=.834). Conclusions In this preliminary experience, the use of IVUS during EVAR was feasible with no registered post-operative complications. A significant reduction of contrast medium usage and radiation exposure was observer with the use of IVUS. The IVUS is an adjunctive tool to consider in the vascular surgeon armamentarium especially in centres where advanced radiological tools of imaging fusion are not available.
Single-centre experience and preliminary Results of intravascular ultrasound in endovascular aneurysm repair / Pecoraro, Felice; Bracale, Umberto M; Farina, Arduino; Badalamenti, Giovanni; Ferlito, Francesca; Lachat, Mario; Dinoto, Ettore; Asti, Vincenzo; Bajardi, Guido. - In: ANNALS OF VASCULAR SURGERY. - ISSN 0890-5096. - 56:(2019), pp. 209-215. [10.1016/j.avsg.2018.09.016]
Single-centre experience and preliminary Results of intravascular ultrasound in endovascular aneurysm repair
Bracale, Umberto M;
2019
Abstract
Intravascular ultrasound (IVUS) has been introduced as diagnostic adjunct to provide new insights in the diagnosis and therapy of vascular disease. Herein we compared the outcomes of conventional endovascular aneurysm repair (EVAR) and EVAR with IVUS in patients presenting infrarenal abdominal aortic aneurysm using a propensity-matched cohort. Methods From May 2013 to August 2017, 221 patients were retrospectively analysed. 122 patients were eligible for inclusion and underwent to propensity score matching. Perioperative mortality and morbidity, renal function impairment, endoleak incidence, mean contrast medium usage, operative time, radiation exposure [including fluoroscopy time, dose-area product (DAP) and digital subtraction angiography (DSA) runs] , survival and freedom from reintervention were the outcomes measured. Results After matching, 52 patients were included, 26 in the conventional EVAR group and 26 in the EVAR with IVUS group. No perioperative mortality or type I/III endoleak were registered. One perioperative lymphatic fistula and one iliac limb occlusion were observed. In the EVAR with IVUS group, a significant reduction of contrast medium (92[vs51±17] vs 51[20-68] ml; P=.003) and radiation exposure including fluoroscopy time (12 [9-16] vs 20 [12-25] minutes; P=.001); DAP (15 [9-21] vs 32 [16-44] G*cm 2 ; P=.002); DSA runs (2 [1-3] vs 3 [2-4]; P=.04)was reported. No differences were observed in term of glomerular filtration rate (86[45-121] vs 90[38-117] ml/min; P=.14) and operation time (176[124-210] vs179[120-210]; P=.48). Survival at 36 months was 93% for standard EVAR and 92% for EVAR with IVUS (P=.845). Freedom from reintervention at 36 months was 85.5% in both groups (P=.834). Conclusions In this preliminary experience, the use of IVUS during EVAR was feasible with no registered post-operative complications. A significant reduction of contrast medium usage and radiation exposure was observer with the use of IVUS. The IVUS is an adjunctive tool to consider in the vascular surgeon armamentarium especially in centres where advanced radiological tools of imaging fusion are not available.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
