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The value of intravascular phased-array imaging in endovascular treatment of thoracic aortic pathology
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
2011 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 52, no 3, 285-290 p.Article in journal (Refereed) Published
Abstract [en]

Background Careful pre-, intra- and postoperative diagnostics in endovascular treatment of thoracic aortic pathology is crucial for a favourable outcome. Computer tomography (CT) and digitally subtracted angiography (DSA) do not always provide sufficient diagnostic information. Purpose To report our primary experiences of using intraluminal phased-array imaging (IPAI) as an additive tool for diagnostics and endovascular treatment of thoracic aortic pathology. Material and Methods Eleven patients, nine men and two women (mean age 60, range 45) were examined intraoperatively with IPAI in stentgraft procedures of thoracic aortic pathology. Results IPAI could detect and visualize the entries and re-entries in the intima. Aortic branch vessels could be visualized for patency both during and immediately after stentgraft deployment. It was also possible to detect ceased blood flow in the false lumen or aneurysmal sac after stentgraft deployment. Conclusion IPAI is a helpful tool for diagnostics and for guiding stentgraft placing in the treatment of thoracic aortic pathology.

Place, publisher, year, edition, pages
2011. Vol. 52, no 3, 285-290 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-152741DOI: 10.1258/ar.2010.100040PubMedID: 21498364OAI: oai:DiVA.org:uu-152741DiVA: diva2:413910
Available from: 2011-04-29 Created: 2011-04-29 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Aspects on Imaging and Endovascular Treatment of Aortic Dissection and Aneurysm
Open this publication in new window or tab >>Aspects on Imaging and Endovascular Treatment of Aortic Dissection and Aneurysm
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 49 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 850
Keyword
Aneurysms, aorta, stents, ultrasound, colour Doppler, vascular, interventional, aortic dissection, complicated, TEVAR, EVAR, re-intervention, survival, thrombosis, false lumen, aortic remodelling
National Category
Medical and Health Sciences
Research subject
Radiology
Identifiers
urn:nbn:se:uu:diva-187464 (URN)978-91-554-8559-7 (ISBN)
Public defence
2013-02-01, Hedstrandsalen, Akademiska Sjukhuset, Ing 70, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-01-10 Created: 2012-12-06 Last updated: 2013-02-11Bibliographically approved

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Eriksson, Mats-OlaNyman, Rickard

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