Value of intravascular ultrasound for endovascular stent-graft placement in aortic dissection and aneurysm.
BACKGROUND
Endovascular stent-graft placement is a new concept for the treatment of aortic dissection and aneurysm. Intravascular ultrasound (IVUS) with established diagnostic features may be instrumental in guiding endovascular procedures.


METHODS
We performed IVUS and digital angiography before, during, and after implantation of 47 stent grafts in 40 patients with Stanford type B dissection (26 patients, 28 stent grafts), thoracic aneurysm (9 patients, 11 stent grafts), and abdominal aneurysm (5 patients, 8 stent grafts).


RESULTS
IVUS could clearly identify the aortic anatomy and differentiate between true and false lumen in all cases of dissection. In four patients with type B dissection extending from the thoracic to the abdominal aorta the true lumen was exclusively identified by IVUS, and thus, essential for safe execution of the procedure. In another patient stent-graft placement in the aorta was optimized by covering a second entry detected by IVUS, but undetected by angiography. The site of stent implantation, the true and false lumen, as well as entry and reentry were always identified in both thoracic and abdominal aorta. In comparison with angiography, IVUS information led to additional balloon molding due to incomplete stent apposition in seven cases.


CONCLUSIONS
As an adjunctive imaging modality IVUS is likely to improve stent-graft placement in aortic type B dissection, especially in patients with abdominal extension.
Koschyk
Dietmar H
DH
Department of Cardiology, University Hospital Hamburg-Eppendorf, Medical Clinic, Martinistrasse 52, 20246 Hamburg, Germany. koschyk@uke.uni-hamburg.de
Meinertz
Thomas
T
Hofmann
Thomas
T
Kodolitsch
Yskert V
YV
Dieckmann
Christoph
C
Wolf
Walter
W
Knap
Malgorzata
M
Kiraly
Zsolt
Z
Steffen
Wolfgang
W
Beythien
Christian
C
Lund
Gunnar
G
Rehders
Tim
T
Nienaber
Christoph A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D018084:Ultrasonography, Interventional