Intravascular Ultrasound During Endovascular Repair of Traumatic Aortic Injury:
Impact on Operative Results and Postoperative Complications
James C. Etheridge MHS, S. Sadie Ahanchi MD, David J. Dexter MD, Brandon C. Cain MD, Jay N. Collins MD*, Jean M. Panneton MD
Division of Vascular Surgery
Eastern Virginia Medical School, Norfolk, VA
Intravascular ultrasound (IVUS) may provide more accurate aortic measurements than initial CT images in traumatic aortic injury (TAI) patients.
IVUS may convey additional benefits in the perioperative period.
We assessed the impact of intraoperative IVUS on operative outcomes and postoperative complications in patients undergoing endovascular TAI repair.
Retrospective chart review was conducted for all endovascular TAI repairs from 2005-2015.
Primary endpoints were aortic-related complications (aortic-related mortality, stroke, and spinal cord ischemia) and device-related complications (graft collapse, migration, endoleak, and reintervention).
Secondary endpoints were operative time, contrast load, branch vessel coverage, intraoperative adjunct procedures, and graft conformation on completion.
Semi-automated volumetric analysis and remodeling calculation was performed on initial and first follow-up CT studies. Total aortic volume and mural volume were calculated from the LCCA to the level of the T10 vertebral body (Fig 1).
25 patients underwent endovascular TAI repair: 14 with IVUS and 11 without IVUS.
Demographics, comorbidities, and injury patterns did not significantly differ between treatment groups (Table I).
The IVUS cohort had less bird-beaking and branch vessel coverage with trends towards decreased contrast load and intraoperative adjunct procedure requirements (Table II).
No differences in aortic-related complications were noted over a median follow-up of 185 days; non-IVUS patients were more likely to experience device-related complications during follow-up (Table II).
Device-related complications included one case of symptomatic endograft collapse with reintervention and subsequent migration; two cases of asymptomatic graft migration; and one case of asymptomatic proximal infolding.
Proximal neck diameter was larger when measured by IVUS compared to initial CT. Endografts placed following IVUS were oversized more than those placed without IVUS (Fig 2).
Aortic remodeling rates were higher among IVUS patients; however, this finding did not approach significance (Table III).
SUMMARY & RECOMMENDATIONS
IVUS alters measurement of aortic lumen diameter with significant impacts on endograft sizing.
Improved operative results and reduced incidence of device-related complications were associated with use of IVUS.
IVUS-based endograft sizing may enhance the rate of aortic remodeling following endovascular TAI repair.
These findings carry significant implications for long-term graft stability, an area of continued concern in this patient population. Multicenter analyses will likely be necessary to control for potential confounders.