Pecoraro Felice, Bracale Umberto M, Farina Arduino, Badalamenti Giovanni, Ferlito Francesca, Lachat Mario, Dinoto Ettore, Asti Vincenzo, Bajardi Guido
Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Vascular Surgery Unit, Palermo, Italy.
Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
Ann Vasc Surg. 2019 Apr;56:209-215. doi: 10.1016/j.avsg.2018.09.016. Epub 2018 Nov 27.
Intravascular ultrasound (IVUS) has been introduced as diagnostic adjunct to provide new insights into the diagnosis and therapy of vascular disease. Herein, we compared the outcomes of conventional endovascular aneurysm repair (EVAR) and EVAR with IVUS in patients presenting with infrarenal abdominal aortic aneurysm using a propensity-matched cohort.
From May 2013 to August 2017, 221 patients were retrospectively analyzed. Of that, 122 patients were eligible for inclusion and underwent propensity score matching. Perioperative mortality and morbidity, renal function impairment, endoleak incidence, mean contrast medium usage, operative time, radiation exposure (including fluoroscopy time, dose-area product [DAP], and digital subtraction angiography [DSA] runs), survival, and freedom from reintervention were the outcomes measured.
After matching, 52 patients were included, 26 in the conventional EVAR group and 26 in the EVAR with IVUS group. No perioperative mortality or type I/III endoleak were registered. One perioperative lymphatic fistula and one iliac limb occlusion were observed. In the EVAR with IVUS group, a significant reduction of contrast medium (92 [vs. 51 ± 17] vs. 51 [20-68] mL; P = 0.003) and radiation exposure including fluoroscopy time (12 [9-16] vs. 20 [12-25] min; P = 0.001), DAP (15 [9-21] vs. 32 [16-44] G*cm; P = 0.002), and DSA runs (2 [1-3] vs. 3 [2-4]; P = 0.04) was reported. No differences were observed in terms of glomerular filtration rate (86 [45-121] vs. 90 [38-117] mL/min; P = 0.14) and operation time (176 [124-210] vs. 179 [120-210]; P = 0.48). Survival at 36 months was 93% for standard EVAR and 92% for EVAR with IVUS (P = 0.845). Freedom from reintervention at 36 months was 85.5% in both the groups (P = 0.834).
In this preliminary experience, the use of IVUS during EVAR was feasible with no registered postoperative complications. A significant reduction of contrast medium usage and radiation exposure was observed with the use of IVUS. The IVUS is an adjunctive tool to consider in the vascular surgeon armamentarium, especially in centers where advanced radiological tools of imaging fusion are not available.
血管内超声（IVUS）已作为一种诊断辅助手段被引入，为血管疾病的诊断和治疗提供新的见解。在此，我们使用倾向评分匹配队列比较了传统血管腔内修复术（EVAR）与使用IVUS的EVAR在肾下腹主动脉瘤患者中的治疗效果。
回顾性分析2013年5月至2017年8月期间的221例患者。其中，122例患者符合纳入标准并进行了倾向评分匹配。测量的结果包括围手术期死亡率和发病率、肾功能损害、内漏发生率、平均造影剂用量、手术时间、辐射暴露（包括透视时间、剂量面积乘积[DAP]和数字减影血管造影[DSA]次数）、生存率以及再次干预的自由度。
匹配后，纳入52例患者，传统EVAR组26例，IVUS辅助EVAR组26例。未记录到围手术期死亡或I/III型内漏。观察到1例围手术期淋巴瘘和1例髂支闭塞。在IVUS辅助EVAR组中，造影剂用量（92[51±17] vs. 51[20 - 68] mL；P = 0.003）以及包括透视时间（12[9 - 16] vs. 20[12 - 25] min；P = 0.001）、DAP（15[9 - 21] vs. 32[16 - 44] G*cm；P = 0.002）和DSA次数（2[1 - 3] vs. 3[2 - 4]；P = 0.04）在内的辐射暴露均显著降低。在肾小球滤过率（86[45 - 121] vs. 90[38 - 117] mL/min；P = 0.14）和手术时间（176[124 - 210] vs. 179[120 - 210]；P = 0.48）方面未观察到差异。标准EVAR组36个月生存率为93%，IVUS辅助EVAR组为92%（P = 0.845）。两组36个月时再次干预的自由度均为85.5%（P = 0.834）。
在这项初步经验中，EVAR术中使用IVUS是可行的，未记录到术后并发症。使用IVUS观察到造影剂用量和辐射暴露显著减少。IVUS是血管外科医生应考虑使用的辅助工具，尤其是在无法获得先进影像融合放射学工具的中心。
