Intravascular ultrasound is a critical tool for accurate endograft sizing in the management of blunt thoracic aortic injury

Abstract

The ALD of patients with BTAI is significantly larger when it is measured by IVUS at the time of TEVAR compared with at the time of initial CTA. This difference in ALD may translate to undersizing of endografts used in TEVAR for BTAI. IVUS at the time of TEVAR provides a more accurate measurement of the actual ALD and should be used for endograft sizing for patients with BTAI.

Comparison of intravascular ultrasound- and centerline computed tomography-determined aortic diameters during thoracic endovascular aortic repair

“…Previous studies have evaluated the utility of IVUS in TEVAR for blunt traumatic aortic injuries. 11,16 Wallace et al 11 showed that IVUS resulted in larger aortic diameter measurements compared with preoperative centerline CTA in blunt traumatic aortic injuries. They attributed this difference to the overall intravascular volume depletion of these patients, who are often in shock from concomitant injuries at the time of the initial CTA.…”

“…However, preoperative and intraoperative hemodynamic parameters were not reliably recorded to confirm this explanation. 11 Our study sought to expand on the potential utility of IVUS in determining aortic diameters during elective TEVAR in wellhydrated patients. We found a statistically significant correlation between IVUS-and CTA-determined aortic diameters, with a correlation coefficient of 0.62 and a P value of <.001 ( Fig 5).…”

“…10 In addition, the aortic diameter can be affected by the overall volume status of the patient, which may be different at the time of the CT scan compared with TEVAR. 11 Finally, the centerline reconstruction algorithms create an idealized straightened aorta based on the center of the flow lumen, whereas the orientation of the stent graft within the aorta at the time of deployment may not be along the perfect centerline.…”

“…Previous studies in traumatic aortic transections have shown a significant difference between IVUS-and CTA-derived stent graft sizing. 11 However, detailed comparison between IVUSand CTA-determined aortic diameters during TEVAR for nontraumatic aortic pathology has been lacking. Therefore, our study compared the centerline CTAand IVUS-determined aortic diameters along the descending thoracic aorta in patients undergoing TEVAR for nontraumatic aortic pathology.…”

Intravascular Ultrasound Characterization of a Tissue-Engineered Vascular Graft in an Ovine Model

“…It is most frequently described in the adult population with placement of stents for the treatment of aneurysms or atherosclerosis [6–10]. The advantages of this technique are a limitation of contrast use, a 2-dimensional view of the vessel lumen, an ability to determine true from false lumens, and accurate assessment of stent apposition to the luminal wall [11–13].…”