Abstract
BackgroundAn intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results. However, intrahepatic vascular exploration was rarely tested and was always associated with X-ray techniques. The aim of this study was to demonstrate the feasibility to navigate through the whole liver using an IVUSc, providing high-quality images and making it unnecessary to use ionizing radiation.MethodsAn ex vivo pig visceral block and an in vivo pig model were used in this study. The IVUS equipment was composed of an US system, and of an 8 French lateral firing IVUSc capable of producing 90-degree sector images in the longitudinal plane. After accessing the intravascular space with the IVUSc into the models, predetermined anatomical landmarks were visualized from the inferior vena cava and hepatic veins and corroborated.ResultsIVUS navigation was achieved in both models successfully. The entire navigation protocol took 87 and 48 min respectively, and 100% (21/21) and 96.15% (25/26) of the landmarks were correctly identified with the IVUSc alone in the ex vivo and in vivo models respectively. IVUS allowed to clearly visualize the vasculature beyond third-order branches of the hepatic and portal veins.ConclusionsA complete IVUS liver navigation is feasible using the IVUSc alone, making it unnecessary to use ionizing radiation. This approach provides high-definition and real-time images of the complex liver structure and offers a great potential for future clinical applications during diagnostic and therapeutic interventions.
Highlights
An intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results
These IVUS approaches were scarcely attempted in the liver, and as far as we know, they were exclusively related to transjugular intrahepatic portosystemic shunts (TIPS) [5,6,7,8,9] and direct intrahepatic portocaval shunts (DIPS) [10,11,12], using ionizing radiation and remaining in the lumen of the inferior vena cava (IVC)
In the in vivo pig model, IVUS navigation was accomplished without the need for any other extra medical imaging method (US/X-rays), recognizing 96.15% (25/26, left lateral Hepatic vein (HV) recognized later, see below) of landmarks in a total time of 48 min
Summary
An intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results. An IVUSc was developed for intracardiac and intraluminal exploration, and during cardiovascular interventions, intracardiac echocardiography was reported as a powerful guide in multiple procedures These IVUS approaches were scarcely attempted in the liver, and as far as we know, they were exclusively related to transjugular intrahepatic portosystemic shunts (TIPS) [5,6,7,8,9] and direct intrahepatic portocaval shunts (DIPS) [10,11,12], using ionizing radiation and remaining in the lumen of the inferior vena cava (IVC). There is only one report describing intrahepatic IVUS navigation through hepatic veins with diagnostic intentions, and relying on fluoroscopic guidance [13]
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