Endoluminal AAA repair using intravascular ultrasound for graft planning and deployment: A 2-year community-based experience

David P. Slovut, Lewis C. Ofstein, J. Michael Bacharach

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose: To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms. Methods: One hundred seventy patients (143 men; mean age 73.6±7.2 years, range 51-89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall. Results: Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3%) aortic necks; in 36 (25.7%), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8%) cases (1 [0.6%] acute conversion and 1 access failure). There were 2 (1.2%) periprocedural deaths related to bowel ischemia. Four (2.3%) patients developed graft occlusion/kinking and 2 (1.2%) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1-25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0%±2.8%. Sixteen (9.4%) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5%±3.2%). Conclusions: Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.

Original languageEnglish (US)
Pages (from-to)463-475
Number of pages13
JournalJournal of Endovascular Therapy
Volume10
Issue number3
DOIs
StatePublished - Jun 2003
Externally publishedYes

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Angioplasty
varespladib methyl
Transplants
Digital Subtraction Angiography
Stents
Atherosclerotic Plaques
Equipment Failure
Endoleak
Abdominal Aortic Aneurysm
Kaplan-Meier Estimate
Renal Insufficiency
Rupture
Dialysis
Ischemia
Extremities
Logistic Models
Regression Analysis
Equipment and Supplies
Survival

Keywords

  • Abdominal aortic aneurysm
  • Ancure stent-graft
  • AneuRx stent-graft
  • Aortic neck
  • Atherosclerosis
  • Endovascular repair
  • Intravascular ultrasound
  • Outcome analysis
  • Secondary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Endoluminal AAA repair using intravascular ultrasound for graft planning and deployment : A 2-year community-based experience. / Slovut, David P.; Ofstein, Lewis C.; Bacharach, J. Michael.

In: Journal of Endovascular Therapy, Vol. 10, No. 3, 06.2003, p. 463-475.

Research output: Contribution to journalArticle

Slovut, David P. ; Ofstein, Lewis C. ; Bacharach, J. Michael. / Endoluminal AAA repair using intravascular ultrasound for graft planning and deployment : A 2-year community-based experience. In: Journal of Endovascular Therapy. 2003 ; Vol. 10, No. 3. pp. 463-475.
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abstract = "Purpose: To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms. Methods: One hundred seventy patients (143 men; mean age 73.6±7.2 years, range 51-89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall. Results: Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3{\%}) aortic necks; in 36 (25.7{\%}), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8{\%}) cases (1 [0.6{\%}] acute conversion and 1 access failure). There were 2 (1.2{\%}) periprocedural deaths related to bowel ischemia. Four (2.3{\%}) patients developed graft occlusion/kinking and 2 (1.2{\%}) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1-25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0{\%}±2.8{\%}. Sixteen (9.4{\%}) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5{\%}±3.2{\%}). Conclusions: Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.",
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N2 - Purpose: To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms. Methods: One hundred seventy patients (143 men; mean age 73.6±7.2 years, range 51-89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall. Results: Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3%) aortic necks; in 36 (25.7%), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8%) cases (1 [0.6%] acute conversion and 1 access failure). There were 2 (1.2%) periprocedural deaths related to bowel ischemia. Four (2.3%) patients developed graft occlusion/kinking and 2 (1.2%) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1-25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0%±2.8%. Sixteen (9.4%) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5%±3.2%). Conclusions: Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.

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KW - Intravascular ultrasound

KW - Outcome analysis

KW - Secondary intervention

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