IVUS guidance of thoracic and complex abdominal aortic aneurysm stent-graft repairs using an intracardiac echocardiography probe: preliminary report.
OBJECTIVE
To report our learning experience using an intracardiac echocardiography (ICE) probe to guide endovascular aortic procedures.


METHODS
Between November 1999 and July 2001, 17 patients (12 men; mean age 73.1+/-2.3 years) underwent endovascular repair of 9 thoracic, 6 complex abdominal, and 2 thoracoabdominal aortic aneurysms. The most suitable dimensions and configuration of the stent-graft were based on preoperative computed tomographic (CTA) or magnetic resonance (MRA) angiography. Intraoperative intravascular ultrasound (IVUS) imaging was obtained using a 9-F, 9-MHz ICE probe, 110 cm in length, inserted through a 10-F, 55 degrees precurved long polyethylene sheath.


RESULTS
The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, interrogation with the ICE probe visualized the aortic arch and descending thoracoabdominal aorta without position-related artefacts and identified the sites of stent-graft fixation. After stent-graft deployment, visualization with the ICE probe detected the need for additional procedures in 8 patients, including 2 incompletely expanded thoracic grafts, which were treated with adjunctive balloon angioplasty. In 1 patient, ICE probe interrogation determined that the lesion was inappropriate for endovascular exclusion.


CONCLUSIONS
ICE probe interrogation provides accurate information on the anatomy of thoracic and abdominal aortic aneurysms and allows rapid identification of attachment sites and stent-graft characteristics. It might be considered as a valid imaging modality for monitoring all phases of endovascular procedures.
Zanchetta
Mario
M
Department of Cardiovascular Diseases, Cittadella Civic Hospital, Padua, Italy.
Rigatelli
Gianluca
G
Pedon
Luigi
L
Zennaro
Marco
M
Ronsivalle
Salvatore
S
Maiolino
Pietro
P
D000368:Aged; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004452:Echocardiography / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D015607:Stents; D018084:Ultrasonography, Interventional / Q000295:instrumentation*