O-161 - INTRAVASCULAR ULTRASOUND (IVUS) IN DETECTION OF BRIDGING STENT GRAFT INSTABILITY DURING B-FEVAR PROCEDURES: A MULTICENTRE STUDY ON 314 BRIDGING STENT GRAFTS.

TOPIC:
Vascular Imaging
AUTHORS:
Asciutto G. (Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Ibrahim A. (Department of Vascular and Endovascular Surgery, University Hospital Münster ~ Münster ~ Germany) , Leone N. (Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara ~ Modena ~ Italy) , Gennai S. (Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara ~ Modena ~ Italy) , Piazza M. (Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University ~ Padua ~ Italy) , Antonello M. (Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University ~ Padua ~ Italy) , Wanhainen A. (Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Mani K. (Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Lindström D. (Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University ~ Uppsala ~ Sweden) , Struk L. (Department of Vascular and Endovascular Surgery, University Hospital Münster ~ Münster ~ Germany) , Oberhuber A. (Department of Vascular and Endovascular Surgery, University Hospital Münster ~ Münster ~ Germany)
Introduction:
The use of intravascular ultrasound (IVUS) reduces contrast medium usage and radiation exposure during conventional endovascular aneurysm repair (EVAR). Its potential impact in advanced EVAR procedures such as branched and fenestrated EVAR (B-FEVAR) has not been fully investigated yet. The aims of this prospective multicentre study was to evaluate safety and efficacy of IVUS in detecting issues on bridging stent grafts (bSGs) during B-FEVAR.
Methods:
A multicentre prospective study on 83 patients (68.7% males; median age 72 years [range 65-77 years]) treated due to complex aortic aneurysm (thoracoabdominal, pararenal or juxtarenal) between January 2019 and September 2021. The patients underwent BEVAR in 73 cases (22 off-the-shelf; 51 custom-made), 8 FEVAR (custom-made) and 2 combined B-FEVAR (custom-made) comprising a total of 331 potential target vessel. The study assessed IVUS ability to detect immediate branch instability after visceral stenting in terms of 1) technical success of the IVUS-assessment in each bSG, 2) IVUS-findings compared to intraoperative angiography, 3) incidence of postoperative computed tomography angiography findings potentially non-detected with intraoperative IVUS, and 4) absence of IVUS-related adverse events.
Results:
There were no IVUS-related adverse events. Eight bSGs could not be examined due to a malfunction of the IVUS catheter, in 7 cases the bSG could not be accessed (5 due to lost wire and 2 due to failing in advancing the IVUS catheter over the wire). In one case the target vessel could not be accessed and connected to the aortic stent graft while in one case the branch was left unconnected to reduce the risk of spinal cord ischemia. These two failures were considered not technical failures and excluded from the analysis. The technical success of the IVUS-assessment was achieved in 95.4% (314/329) of all eligible bSGs. A total of 10 bSG showed signs of instability by means of IVUS (all more than 50% stenosis of the bSG), of which only 1 was noted at the completion target vessel angiography. The IVUS assessment led to an immediate revision in all 10 cases (2 coeliac trunk, 3 SMA, 5 renal arteries). All unstable bSGs were detected in patients undergoing primary BEVAR. In two of the 314 bSGs (0,006%) where IVUS did not show any sign of instability by the end of the index procedure, re-intervention became necessary during the first 30 postoperative days (one SMA occlusion on the day of the index procedure; one renal artery occlusion on postoperative day three). In both cases. The 30-days postoperative CT (available in 49/83) cases showed bSG instability requiring reintervention in 2 bSG of the cases on the same patient (2%). Both bSGs were relined.
Conclusion:
This multicenter study suggests that IVUS is a safe and potentially valuable adjunct imaging technology for intraoperative detection of bSG instability in BEVAR. Further long-term investigations on larger cohorts of patients are required to validate these promising results. Furthermore, this minimal invasive diagnostic method should also be compared with alternative technologies such as cone beam CT in terms of efficiency, radiation exposure, procedural time, and costs.