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 Scopus citations

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
Publication statusPublished - Jun 1 2003

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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

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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