Limited role for IVUS in the endovascular repair of aortoiliac aneurysms.
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.
Lipsitz
E C
EC
Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10467, USA. Elipsitz@aol.com
Ohki
T
T
Veith
F J
FJ
Berdejo
G
G
Suggs
W D
WD
Wain
R A
RA
Mehta
M
M
Valladares
J
J
McKay
J
J
D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D003955:Diagnostic Tests, Routine; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D007432:Intraoperative Period; D011237:Predictive Value of Tests; D018084:Ultrasonography, Interventional / Q000379:methods / Q000706:statistics & numerical data; D014481:United States