Transesophageal echocardiography–guided algorithm for stent-graft implantation in aortic dissection

Abstract

TEE algorithm is an easy and useful tool in the operating room to guide correct stent-graft positioning in type B aortic dissection.

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

“…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).…”

“…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).…”

Echocardiography images of endovascular mal-aligned stent grafts

“…Intraoperative TEE identifies the deployment aortic zone, and provides a sensitive means of detecting endoleaks. 1 An initial stent graft was deployed proximal to the left subclavian artery. A second stent graft overlapping the distal end of the first was required to cover the descending aortic thoracic aneurysm.…”

Images in Anesthesia: Echo contrast as an adjunct to intraoperative angiography in the detection of endoleaks

“…Intraoperative transesophageal echocardiographic (TEE) examination of the endovascular stent provides a sensitive and safe means of detecting endoleaks, with a published algorithm outlining a systematic approach. 1 Colour Doppler interrogation of the stent is used to identify possible endoleaks. Quantification of the velocity within the endoleak using pulse wave Doppler helps to discriminate true leaks from "porosity", with a minimum peak velocity of 50 cm·sec -1 as the suggested cut-off.…”