Primary endoleakage in endovascular treatment of the thoracic aorta: Importance of intraoperative transesophageal echocardiography

Abstract

During implantation of a stent-graft in the descending thoracic aorta, transesophageal echocardiography provides information in addition to that provided by angiography, improving immediate and late procedural results.

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

“…The success of TEVAR is critically dependent on high-quality, accurate imaging before, during, and after stent-graft placement. 199 Although invasive catheter-based angiography ( Figure 14) is the method of first choice for the guidance of aortic stent-graft placement, 42 TEE offers definite advantages in the hands of an experienced examiner, 59,60,62,200,201 TEE is particularly useful in the operating room and provides contributions at various phases of the procedure. In patients with type B aortic dissection, guidewire advancement and positioning can be guided by both fluoroscopy and TEE.…”

“…Therefore, just before proximal stent-graft deployment, TEE is essential for selecting an aortic wall segment without protruding plaques and confirming selection of the stent-graft diameter. 59,60,62 Orientation and navigation as guided by TEE can be complemented by the use of IVUS (usually with 10-MHz transducers) over a guidewire, thereby confirming or correcting navigation in the true lumen even at the level of the abdominal aorta and iliac arteries. In addition, intraprocedural IVUS may clarify the mechanism of branch vessel compromise when malperfusion is suspected (e.g., dynamic vs static obstruction of a branch vessel).…”

“…This intraluminal perspective can provide information that supplements the other imaging modalities. [59][60][61][62] Using the pullback technique, luminal diameter, cross-sectional area, and wall thickness can be measured. In addition to providing measurements, IVUS also provides qualitative information on nearly all aortic pathologies, including aortic aneurysms, aortic dissections, atherosclerosis, penetrating ulcers, and traumatic lesions (Figures 13 and 14).…”

A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility

“…The sensitivity of TOE in detecting small amounts of flow into the aneurysmal sac makes it ideal and in many instances it has surpassed angiography [91]. In one case series, angiography failed to detect six of the eight endoleaks found by TOE [92]. However, when endoleaks are observed by TOE and not by angiography, it creates a difficult dilemma.…”

Transesophageal echocardiographic diagnosis of a failed balloon catheter during endovascular stenting of a descending thoracic aneurysm

“…A Cook Coda balloon (Cook Inc., Bloomington, IN, USA) 40 mm was inflated within the two stent grafts to achieve complete stent expansion and minimize primary endoleaks. 2 Transesophageal echocardiography images of the balloon catheter revealed incomplete expansion of the balloon during the inflation period ( Figure 1). The balloon catheter was replaced, and full expansion of the balloon was achieved (Figure 2).…”