Intravascular Ultrasound in Endovascular Stent-Grafts for Peripheral Aneurysm: A Clinical Study

Abstract

Purpose:

To evaluate the potential diagnostic information of intraprocedural intravascular ultrasound (IVUS) in patients undergoing endovascular stent-grafting for peripheral aneurysm.

Methods:

IVUS was used in 17 patients preprocedurally to measure the diameter of the proximal and distal neck and the length of the aneurysm. Balloon and stent-graft sizes were selected based on these measurements. Following stent-graft deployment, angiography and IVUS were used to document stent apposition and the configuration and diameter of the stent-graft.

Results:

Stent-graft insertion was considered successful in 8 patients based on angiography and IVUS images. In 9 others, both imaging modalities showed inadequate results, necessitating 12 additional procedures: balloon angioplasty for stent-graft stenosis (2) and inadequate stent-graft apposition (1); an additional stent-graft (4); an extra stent (1); thrombectomy (2); and conversion (2) for inadequate stent-graft position and a graft rupture. In these patients, intraprocedural IVUS was superior to angiography in contributing vital information to aid in the selection of the additional interventions.

Conclusions:

During management of peripheral aneurysms with endovascular stent-grafts, IVUS monitoring was a useful adjunct when the initial procedure was unsatisfactory and/or when intraprocedural angiographic studies were inconclusive.

Keywords

endovascular grafting procedural assessment imaging Palmaz stent polytetrafluoroethylene

Get full access to this article

View all access options for this article.

References

Gussenhoven

Essed

Lancée

. Arterial wall characteristics determined by intravascular ultrasound imaging: An in vitro study. J Am Coll Cardiol 1989; 14: 947–952.

The

SHK

Gussenhoven

Zhong

. The effect of balloon angioplasty on the femoral artery evaluated with intravascular ultrasound imaging. Circulation 1992; 86: 483–493.

Gerritsen

Gussenhoven

The

SHK

. Intravascular ultrasonography before and after intervention: In vivo comparison with angiography. J Vasc Surg 1993; 80: 31–40.

Tabbara

White

Cavaye

. In vivo human comparison of intravascular ultrasonography and angiography. J Vasc Surg 1991; 14: 496–504.

Cavaye

White

Lerman

. Usefulness of intravascular ultrasound imaging for detecting experimentally induced aortic dissection in dogs and for determining the effectiveness of endoluminal stenting. Am J Cardiol 1992; 69: 705–707.

Katzen

. Current status of intravascular ultrasonography. Radiol Clin North Am 1992; 30: 895–905.

Palmaz

Sprague

Palmaz

. Physical properties of polytetrafluoroethylene bypass material after balloon dilatation. J Vasc Interv Radiol 1996; 7: 657–663.

Marin

Veith

Lyon

. Transfemoral endovascular repair of iliac artery aneurysms. Am J Surg 1995; 170: 179–182.

Palmaz

. Uses of balloon-expandable stents in combination with PTFE. In: Greenhalgh

, ed. Vascular and Endovascular Surgical Techniques. 3rd ed. Philadelphia, WB Saunders, 1994: 36–42.

10.

Marin

Veith

Cynamon

. Effect of polytetrafluoroethylene covering of Palmaz stents on the development of intimal hyperplasia in human iliac arteries. J Vasc Interv Radiol 1996; 7: 651–656.

11.

Bergeron

Henric

Bonnet

. Tensile characteristics of expanded PTFE for use in endoluminal grafting. J Endovasc Surg 1995; 2: 302–316.

12.

Dorros

Joseph

. Closure of a popliteal arteriovenous fistula using an autologous vein-covered Palmaz stent. J Endovasc Surg 1995; 2: 177–181.

13.

White

Donayre

de Virgilio

. Deployment technique and histopathological evaluation of endoluminal vascular prosthesis used to repair an iliac artery aneurysm. J Endovasc Surg 1996; 3: 262–269.

14.

White

Verbin

Kopchok

. The role of cinefluoroscopy and intravascular ultrasonography in evaluating the deployment of experimental endovascular prostheses. J Vasc Surg 1995; 21: 365–374.

15.

Beebe

. Imaging modalities for aortic endografting. J Endovasc Surg 1997; 4: 111–123.

16.

Gussenhoven

van der Lugt

Strijen

. Displacement sensing device enabling accurate documentation of catheter tip position. In: Roelandt

Gussenhoven

Bom

, eds. Intravascular Ultrasound. Dordrecht, The Netherlands, Kluwer Academic Publishers, 1993: 157–166.

17.

Veith

Abbott

Yao

JST

. Guidelines for development and use of transluminally placed endovascular prosthetic grafts in the arterial system. J Vasc Surg 1995; 21: 670–685.

18.

White

Donayre

Walot

. Preliminary clinical outcome and imaging criterion for endovascular prosthesis deployment in high risk patients with aortoiliac and traumatic arterial lesions. J Vasc Surg 1996; 24: 556–569.