Intravascular Ultrasound May Not Impact Graft Sizing in Endovascular Repair of Blunt Thoracic Aortic Injury.

Vascular and endovascular surgery Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI:10.1177/15385744241264790

Alec Falkenhain, Nicholas Schaper, Tyler Arismendi, Matthew R Smeds, Saideep Bose

{"title":"Intravascular Ultrasound May Not Impact Graft Sizing in Endovascular Repair of Blunt Thoracic Aortic Injury.","authors":"Alec Falkenhain, Nicholas Schaper, Tyler Arismendi, Matthew R Smeds, Saideep Bose","doi":"10.1177/15385744241264790","DOIUrl":null,"url":null,"abstract":"Objectives: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for severe blunt thoracic aortic injuries (BTAI). Successful outcomes rely on accurate endograft sizing, but initial imaging may underestimate aortic diameters. This study examines the impact of intravascular ultrasound (IVUS) on endograft sizing and clinical outcomes in BTAI patients.Methods: A prospectively collected multi-institutional dataset from the Aortic Trauma Foundation was analyzed. Patients with BTAI undergoing TEVAR with IVUS were compared to patients who underwent TEVAR alone. Demographics and operative variables were compared, focusing on IVUS effects on endograft sizing by examining maximal proximal and distal aortic diameter on initial CT imaging compared to the graft diameters used during TEVAR.Results: 293 patients underwent TEVAR for BTAI with IVUS utilized in 124 cases (42.3%). The average graft size in the IVUS and non-IVUS groups were similar proximally (26.91 ± 4.3 mm IVUS vs 27.77 ± 4.7 mm non-IVUS, P = 0.116) and distally (25.96 ± 4.7 mm IVUS vs 26.51 ± 4.7 mm non-IVUS). IVUS did not impact the difference between graft size and initial CT measurements proximally (4.32 ± 4.8 mm IVUS vs 4.23 ± 3.9 mm non-IVUS, P = 0.859) or distally (4.17 ± 5.9 mm IVUS vs 4.50 ± 4.3 mm non-IVUS, P = 0.606). Although delayed hemorrhagic and ischemic stroke occurred less frequently in IVUS patients (0.8% IVUS vs 7.1% non- IVUS, P = 0.024), in-hospital mortality was similar between groups (5.6% IVUS vs 7.7% non-IVUS, P = 0.581).Conclusions: IVUS is not associated with significant changes in endograft sizing compared to sizing based on CT scan alone in BTAI patients. IVUS was not associated with differences in mortality but was associated with a decrease in delayed hemorrhagic and ischemic stroke. Routine IVUS in BTAI patients may not be necessary for accurate sizing, but there may be a relationship between IVUS and stroke.","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vascular and endovascular surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15385744241264790","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/25 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for severe blunt thoracic aortic injuries (BTAI). Successful outcomes rely on accurate endograft sizing, but initial imaging may underestimate aortic diameters. This study examines the impact of intravascular ultrasound (IVUS) on endograft sizing and clinical outcomes in BTAI patients.

Methods: A prospectively collected multi-institutional dataset from the Aortic Trauma Foundation was analyzed. Patients with BTAI undergoing TEVAR with IVUS were compared to patients who underwent TEVAR alone. Demographics and operative variables were compared, focusing on IVUS effects on endograft sizing by examining maximal proximal and distal aortic diameter on initial CT imaging compared to the graft diameters used during TEVAR.

Results: 293 patients underwent TEVAR for BTAI with IVUS utilized in 124 cases (42.3%). The average graft size in the IVUS and non-IVUS groups were similar proximally (26.91 ± 4.3 mm IVUS vs 27.77 ± 4.7 mm non-IVUS, P = 0.116) and distally (25.96 ± 4.7 mm IVUS vs 26.51 ± 4.7 mm non-IVUS). IVUS did not impact the difference between graft size and initial CT measurements proximally (4.32 ± 4.8 mm IVUS vs 4.23 ± 3.9 mm non-IVUS, P = 0.859) or distally (4.17 ± 5.9 mm IVUS vs 4.50 ± 4.3 mm non-IVUS, P = 0.606). Although delayed hemorrhagic and ischemic stroke occurred less frequently in IVUS patients (0.8% IVUS vs 7.1% non- IVUS, P = 0.024), in-hospital mortality was similar between groups (5.6% IVUS vs 7.7% non-IVUS, P = 0.581).

Conclusions: IVUS is not associated with significant changes in endograft sizing compared to sizing based on CT scan alone in BTAI patients. IVUS was not associated with differences in mortality but was associated with a decrease in delayed hemorrhagic and ischemic stroke. Routine IVUS in BTAI patients may not be necessary for accurate sizing, but there may be a relationship between IVUS and stroke.

查看原文本刊更多论文

血管内超声可能不会影响钝性胸主动脉损伤血管内修复的移植物大小。

目的：胸腔内血管主动脉修复术（TEVAR）是治疗严重钝性胸主动脉损伤（BTAI）的首选方法。成功的疗效有赖于准确的内移植物尺寸，但初始成像可能会低估主动脉直径。本研究探讨了血管内超声（IVUS）对 BTAI 患者内移植物大小和临床预后的影响：方法：分析了主动脉创伤基金会收集的多机构前瞻性数据集。方法：对主动脉创伤基金会收集的多机构前瞻性数据集进行了分析，将接受TEVAR和IVUS的BTAI患者与单纯接受TEVAR的患者进行了比较。结果：293 名 BTAI 患者接受了 TEVAR，其中 124 例（42.3%）使用了 IVUS。IVUS组和非IVUS组近端（26.91 ± 4.3 mm IVUS vs 27.77 ± 4.7 mm non-IVUS，P = 0.116）和远端（25.96 ± 4.7 mm IVUS vs 26.51 ± 4.7 mm non-IVUS）的移植物平均尺寸相似。IVUS 对移植物近端（4.32 ± 4.8 mm IVUS vs 4.23 ± 3.9 mm non-IVUS，P = 0.859）或远端（4.17 ± 5.9 mm IVUS vs 4.50 ± 4.3 mm non-IVUS，P = 0.606）尺寸与 CT 初始测量值之间的差异没有影响。虽然IVUS患者发生延迟性出血性和缺血性卒中的频率较低（IVUS为0.8%，非IVUS为7.1%，P = 0.024），但两组患者的院内死亡率相似（IVUS为5.6%，非IVUS为7.7%，P = 0.581）：IVUS与仅根据CT扫描确定的BTAI患者内移植物大小相比，并无明显变化。IVUS与死亡率的差异无关，但与延迟性出血性和缺血性卒中的减少有关。在 BTAI 患者中常规 IVUS 可能不是准确确定尺寸的必要条件，但 IVUS 与中风之间可能存在关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Vascular and endovascular surgery

自引率

0.00%

发文量