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Intravascular Ultrasound with a Vector Phased-Array Probe (AcuNav) Is Feasible in Endovascular Abdominal Aortic Aneurysm Repair
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
2009 (Engelska)Ingår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 50, nr 8, s. 870-875Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The ideal imaging method for endovascular aneurysm repair (EVAR) should provide all data regarding diagnosis, measurements, and guiding of stent-graft deployment. Contrast-enhanced computed tomography (CT) is used for preoperative EVAR planning, together with intraoperative angiography. However, the administered contrast volume might result in contrast-induced nephropathy (CIN). Purpose: To develop a technique for aortic measurements, vessel wall evaluation, and stent-graft positioning by using a vector phased-array intravascular ultrasound probe with color Doppler function (AcuNav) in elective EVAR. Material and Methods: Thirteen elective EVAR patients were included. AcuNav was compared to pre- and postoperative CT examinations, perioperative angiography, and postoperative duplex. Results: Measurements for stent-graft sizing were easily obtained and facilitated by the color Doppler function and corresponded well with CT and angiography. The combined information from AcuNav and fluoroscopy provided exact positioning of the stent graft. An aortic placement of the probe provided superior imaging results compared to an inferior vena cava approach. Detection of endoleak was found to be difficult. No complications were registered. Conclusion: The use of AcuNav combined with fluoroscopy in EVAR was found to be safe, effective, and feasible in planning and guiding EVAR procedures. Best results were seen with the probe placed in the artery. AcuNav might be used to replace contrast-enhanced CT and angiography, hence reducing the risk of CIN, especially in high-risk patients.

Ort, förlag, år, upplaga, sidor
2009. Vol. 50, nr 8, s. 870-875
Nyckelord [en]
aneurysms, aorta, stents, ultrasound, vascular
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-110130DOI: 10.1080/02841850902912010ISI: 000270459200006PubMedID: 19452296OAI: oai:DiVA.org:uu-110130DiVA, id: diva2:275269
Tillgänglig från: 2009-11-04 Skapad: 2009-11-04 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
Ingår i avhandling
1. Aspects on Imaging and Endovascular Treatment of Aortic Dissection and Aneurysm
Öppna denna publikation i ny flik eller fönster >>Aspects on Imaging and Endovascular Treatment of Aortic Dissection and Aneurysm
2013 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Aortic aneurysm and dissections are potentially life threatening conditions. The advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has reduced perioperative mortality and morbidity and are now established therapy methods for treatment of aortic disease. Adequate pre- and intraoperative imaging is important for optimal results in endovascular procedures. However, the standard use of CT and angiography may not always be sufficient to provide necessary information required for treatment, and complementary techniques are warranted in selected cases.

TEVAR in acute complicated type B aortic dissections is proven effective in several reports, but long-term clinical outcome and aortic remodelling are still not fully evaluated.

Intravascular phased array imaging (IPAI) was used in patients undergoing EVAR and TEVAR for aortic aneurysm and dissection. The combined information from IPAI and fluoroscopy allowed exact positioning of the stent graft. The colour Doppler function facilitated detection of blood-flow in relevant arteries during and after the procedures, and it also facilitated control of ceased flow in excluded false lumens or aneurysms.

Clinical early and long-term results after TEVAR for acute complicated type B aortic dissection were investigated in all patients treated between 1999 and 2009 at UppsalaUniversityHospital. Results were favourable regarding survival and permanent neurological complications. Long-term follow-up of aortic morphological changes in the same patient group showed overall significant reduction of aortic and false lumen diameters, and an increase of true lumen diameter. Total thrombosis of the false lumen occured more often in patients with DeBakey IIIa aortic dissection, than in IIIb.

In conclusion, IPAI may be a complementary tool to traditional imaging modalities in EVAR and TEVAR in selected cases. Long-term clinical outcome is excellent with favourable aortic remodeling after TEVAR in patients with acute complicated type B aortic dissection.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2013. s. 49
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 850
Nyckelord
Aneurysms, aorta, stents, ultrasound, colour Doppler, vascular, interventional, aortic dissection, complicated, TEVAR, EVAR, re-intervention, survival, thrombosis, false lumen, aortic remodelling
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Radiologi
Identifikatorer
urn:nbn:se:uu:diva-187464 (URN)978-91-554-8559-7 (ISBN)
Disputation
2013-02-01, Hedstrandsalen, Akademiska Sjukhuset, Ing 70, Uppsala, 09:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2013-01-10 Skapad: 2012-12-06 Senast uppdaterad: 2013-02-11Bibliografiskt granskad

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