Abstract 14832: Comparative Effectiveness of Intravascular Ultrasound versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis

Abstract

Introduction: The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in the treatment of aortic conditions remains unclear. Objective: This systematic review and meta-analysis evaluates the evidence for IVUS use during thoracic (TEVAR) and abdominal (EVAR) endovascular aortic repair. Methods: A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted to identify studies comparing outcomes of patients undergoing TEVAR/EVAR with and without IVUS. The primary outcome was all-cause mortality during follow-up. Secondary outcomes included contrast volume, fluoroscopy time, perioperative mortality, and reinterventions during follow-up. Continuous variables, risk ratios (RRs), and hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted from each study. Pooled analysis was performed using a random-effects model. Results: A total of 6,888 patients (n=4,226 IVUS and n=2,662 non-IVUS) from nine observational studies were included in the meta-analysis. The follow-up period ranged from 9 months to 25 months. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference (WMD) [95% CI] = -34.65 mL [-54.73, -14.57]) and fluoroscopy time (WMD [95% CI] = -6.13 min [-11.10, -1.15]) ( Figure 1A&B ). Perioperative mortality was comparable between both groups (RR [95% CI] = 0.67 [0.40-1.12], respectively). Reintervention rates and all-cause mortality during the follow-up period were similar between the two groups (HR [95% CI] = 0.80 [0.33-1.97], HR [95% CI] = 0.75 [0.47-1.18], respectively) ( Figure 1C ). Conclusions: This systematic review and meta-analysis provides evidence that the use of IVUS enables safe and effective deployment of TEVAR and EVAR with reduced contrast agent usage and shorter fluoroscopy duration. These findings support the potential of IVUS as a valuable tool in endovascular aortic interventions.