Validation of intravascular ultrasound for measurement of aortic diameters: Comparison with multi-detector computed tomography

Abstract

IVUS is a reliable tool for measuring aortic diameter, especially in the descending part of the aorta. However, its pitfalls must be considered to prevent choosing an incorrectly sized stent graft in the acute setting of thoracic endovascular aortic repair.

Hemodynamic changes lead to alterations in aortic diameters and may challenge further stent graft sizing in acute aortic syndrome

“…Our results highlight the relationship between IVUS and CT assessments of the AD in normal and impaired hemodynamic conditions and present limitations in stent graft sizing to consider in emergency situations. Our results were in line with previous data regarding the accuracy of IVUS assessment in patients with acute aortic syndrome (10); however, no further differentiation was conducted in emergency patients with positive shock index to date.…”

“…Stent graft sizing for TEVAR, especially in the aortic arch, can be challenged by the overestimation of the aortic luminal diameter in IVUS owing to off-center measurements and non-tangential views (11,12), but precise sizing of the stent graft is essential to avoid further complications and re-interventions. Taking this into account, measuring the minimum AD at the level distal to the LSA has already been shown to provide a good correlation with CT measurements (10).…”

Impact of Preoperative Anemia and Postoperative Hemoglobin Drop on the Incidence of Acute Kidney Injury and In-Hospital Mortality in Patients With Type B Acute Aortic Syndromes Undergoing Thoracic Endovascular Aortic Repair

“…Specific protocols for each imaging modality have been described previously. [6][7][8][9] Endovascular Procedure Thoracic endovascular aortic repair was performed by an interdisciplinary team of interventional cardiologists, cardiothoracic surgeons, and anesthesiologists at the West German Heart and Vascular Center, Essen, Germany. 5,10,11 The procedure has been described in detail previously.…”

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

“…The present study provides insights into the aortic remodeling process after TEVAR in patients with Type B aortic dissection and illustrates the benefit of IVUS-assisted stent graft sizing in TEVAR over time. Due to the tortuosity of the aortic arch and the drift out of the coaxial axis, IVUS tends to overestimate luminal diameter [ 8 , 10 ]. As a high divergence of measurements is particular seen at level of the LSA, divergent results can be challenging when choosing an appropriate stent graft.…”

“…Furthermore, in cases where CT images lack reliable imaging quality, choosing the correct stent graft can be challenging. Intravascular ultrasound (IVUS) closes this time-gap using real-time characterization of the lesion and relevant diameters including intraluminal assessment [ 8 ], but it is not routinely utilized due to cost inefficiency and a relative lack of availability. Moreover, the benefits of IVUS-guided graft sizing of landing zones in emergency TEVAR in Type B aortic dissection have not yet been conclusively evaluated.…”