Mosarla Ramya C, Heindel Patrick V, Hussain Mohamad A, Schermerhorn Marc, Kuno Toshiki, D'Oria Mario, Li Siling, Secemsky Eric A
New York University Grossman School of Medicine (R.C.M.).
Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women's Hospital (P.V.H., M.A.H.), Harvard Medical School, Boston, MA.
Circ Cardiovasc Interv. 2025 Jan;18(1):e014332. doi: 10.1161/CIRCINTERVENTIONS.124.014332. Epub 2024 Dec 27.
Intravascular ultrasound (IVUS) use in aortic endovascular interventions, including thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR), may have similar benefits to those seen in coronary and peripheral interventions, but limited utilization and outcome data exist.
Centers for Medicare and Medicaid Services claims data were used to identify patients undergoing TEVAR and EVAR from 2016 to 2023. Utilization trends were stratified by region, urbanicity, distressed communities index, community versus academic center, Medicare versus dual enrollment status, indication, urgency, and presence of dissection with malperfusion. Inverse probability weighting was used to assess the impact of IVUS on a composite outcome of repeat aortic intervention or death. Cox regression was used to estimate weighted hazard ratios.
A total of 136 540 patients underwent TEVAR and EVAR, of which 9.8% (13 364) used IVUS. IVUS use increased slightly from 2016 to 2023, driven more by use in TEVAR compared with EVAR, and was higher in academic settings, with Medicare and Medicaid dual enrollment, in the West, with dissections, with malperfusion and for elective procedures. IVUS was associated with a lower risk of the primary outcome at 30-days (hazard ratio, 0.80 [95% CI, 0.73-0.89]; <0.001) and 6-months (hazard ratio, 0.93 [95% CI, 0.87-0.99]; =0.022) for all-comers. Subgroup analysis suggested lower risks of the primary outcome with IVUS use for aneurysm driven by the abdominal segment, malperfusion, thoracoabdominal dissection with malperfusion, thoracoabdominal repair, and chronic kidney disease.
IVUS use has increased slightly in TEVAR and EVAR with heterogeneity in use. IVUS implementation during TEVAR and EVAR was associated with improved early and mid-term outcomes, particularly in certain subsets.
血管内超声（IVUS）在主动脉血管内介入治疗中的应用，包括胸主动脉腔内修复术（TEVAR）和腹主动脉腔内修复术（EVAR），可能具有与冠状动脉和外周介入治疗中所见类似的益处，但相关的应用情况和结局数据有限。
利用医疗保险和医疗补助服务中心的索赔数据，识别2016年至2023年期间接受TEVAR和EVAR治疗的患者。应用趋势按地区、城市化程度、贫困社区指数、社区与学术中心、医疗保险与双重参保状态、适应证、紧急程度以及是否存在夹层伴灌注不良进行分层。采用逆概率加权法评估IVUS对重复主动脉介入治疗或死亡这一复合结局的影响。使用Cox回归估计加权风险比。
共有136540例患者接受了TEVAR和EVAR治疗，其中9.8%（13364例）使用了IVUS。从2016年到2023年，IVUS的使用略有增加，与EVAR相比，TEVAR中的使用增加更为明显，且在学术环境、同时参加医疗保险和医疗补助、西部地区、存在夹层、存在灌注不良以及择期手术中的使用比例更高。对于所有患者，IVUS与30天时（风险比，0.80[95%CI，0.73 - 0.89]；P<0.001）和6个月时（风险比，0.93[95%CI，0.87 - 0.99]；P = 0.022）的主要结局风险较低相关。亚组分析表明，对于由腹段动脉瘤、灌注不良、胸腹夹层伴灌注不良、胸腹修复以及慢性肾脏病导致的动脉瘤，使用IVUS可降低主要结局的风险。
在TEVAR和EVAR中，IVUS的使用略有增加且存在应用异质性。在TEVAR和EVAR过程中应用IVUS与改善早期和中期结局相关，尤其是在某些亚组中。
