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Abstract

Introduction

Endovascular repair has become first-line therapy for traumatic aortic injury. Proper endograft sizing is critical to outcomes following traumatic aortic injury repair; however, the adequacy of standard imaging modalities for this purpose remains uncertain. We assessed the impact of intravascular ultrasound on outcomes of endovascular traumatic aortic injury repair.

Methods

A retrospective review was conducted for all traumatic aortic injury patients from 2005 to 2015. Primary endpoints were 30-day aortic-related complications (aortic-related mortality, stroke, and spinal cord ischemia) and late device-related complications (collapse, migration, endoleak, and reintervention) over the duration of follow-up. Aortic measurements were calculated from three-dimensional-reconstructed computerized tomography studies and intravascular ultrasound images. Aortic remodeling was quantified by volume change between initial and first follow-up computerized tomography scans.

Results

Twenty-five patients were included (mean age 41, 72% male). Intravascular ultrasound was used in 14 patients. No differences in demographics or injury characteristics were observed between intravascular ultrasound and non-intravascular ultrasound patients. Proximal neck diameter was 1.2 mm greater on intraoperative intravascular ultrasound than initial computerized tomography imaging (P = .048). Endograft oversizing in relation to initial computerized tomography was 25% in intravascular ultrasound patients versus 9% in non-intravascular ultrasound patients (P = .001). No significant differences in aortic-related complications were noted. Device-related complications occurred more frequently in the non-intravascular ultrasound group at a mean follow-up of 252 days (36.4% vs. 0%, P = .026). Aortic remodeling rate was 4.41 cm³/day in the intravascular ultrasound group versus 2.34 cm³/day in the non-intravascular ultrasound group (P = .256).

Conclusions

Intravascular ultrasound significantly impacts endograft sizing and was associated with decreased device-related complications following endovascular traumatic aortic injury repair.

Keywords

Traumatic aortic injury blunt aortic injury endovascular repair intravascular ultrasound

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The impact of intravascular ultrasound on outcomes of endovascular repair of blunt traumatic aortic injury

Abstract

Introduction

Methods

Results

Conclusions

Keywords

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References