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.