ObjectiveTo present the value of intravascular ultrasound (IVUS) in diagnosis and treatment of complicated type B aortic dissection (TBD) with malperfusion (MP). Especially the value of IVUS regarding the treatment strategy, reoperation rate, acute kidney injury (AKI) and false lumen thrombosis (FLT) was investigated. MethodsRetrospective analysis of 25 TBD cases with MP treated with endovascular therapy from April 2019 to August 2022. In 17 cases angiography & IVUS were applied during the operation (IVUS group) and in 8 cases angiography was used without IVUS (control group) for final intraoperative control. IVUS was used to assess the true lumen collapse and to decide if additional bare stenting was necessary or not. Details from patients’ charts and documentation from surgeries were analyzed. The endovascular technique included thoracic endovascular aortic repair (TEVAR) with primary entry sealing and -if needed- bare stenting of the true lumen distal of the entry tears using the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique. ResultsAll patients presented with pain localized mostly (48%) in thorax and abdomen. In all patients the proximal entry tear of the dissection was covered using TEVAR. The PETTICOAT technique was applied in 13 cases (52%), whereas most combined procedures were applied in the IVUS group (12 compared to 1; p=0,02). A total of 3 patients (1 in the control group; 12,5% and 2 in the IVUS group; 11,8%) underwent a bowel resection. Totally 8 patients (32%) underwent a reoperation in aorta (3 during the hospital stay). There were no statistical differences between IVUS and control group regarding the preoperative findings, the reoperation rates and the postoperative complications. 5 patients died (4 during the hospital stay), 1 in control and 4 in IVUS group; p=0,53. The follow up included a clinical and a computed tomography angiography (CTA) examination. No statistically significant difference regarding occurrence and extension of FLT was observed between the two groups. ConclusionsThe IVUS and control groups showed no difference in survival rates. The use of IVUS extended the indication for PETTICOAT technique with statistically significant difference. A milder form of AKI presented in the IVUS group compared to the control group. In addition, a stronger correlation between IVUS and the avoidance of an aorta reoperation was observed, though it did not reach statistical significance.