Lie T, Lundbom J, Hatlinghus S, Grønningsaeter A, Ommedal S, Aadahl P, Saether O D, Myhre H O
Department of Biomedical Engineering, University Hospital of Trondheim, Norway.
J Endovasc Surg. 1997 Aug;4(3):272-8. doi: 10.1583/1074-6218(1997)004<0272:UIDEAA>2.0.CO;2.
To evaluate different ultrasound modalities during implantation and follow-up of endovascular grafts for abdominal aortic aneurysm (AAA) exclusion.
Between February 1995 and May 1996, 18 patients (14 men; aged 49 to 80 years, mean 67) were treated with endovascular intervention for infrarenal AAA. Seventeen patients received Mialhe Stentor bifurcated grafts, while one patient was treated with a straight graft for pseudoaneurysm. During and after the implantation, 3.25- and 5-MHz annular array ultrasound probes were used for transabdominal visualization of the endograft. Intravascular ultrasound was applied in combination with angiography for postoperative control.
Intraprocedurally, transabdominal two-dimensional (2D) ultrasound successfully monitored guidewire passage from the groin into the main part of the bifurcated endograft for implantation of the second limb. All implantation procedures were technically successful, but four endoleaks were identified intraprocedurally by 2D ultrasound and angiography. One healed spontaneously, two were treated with endovascular techniques at 1 and 4 months, and the last leak was scheduled for repair when the patient died of probable myocardial infarction at 2 months. During follow-up, 2D ultrasound successfully visualized all the endografts; no endoleaks were found in up to 18 months of surveillance.
Transabdominal ultrasound imaging could be valuable in bifurcated endograft deployment both for guiding guidewire insertion and for controlling wire position before the second graft limb is connected to the main graft. Provided that satisfactory visualization of the entire endograft can be obtained, ultrasound examination may possibly replace arteriography and computed tomographic scanning as a follow-up investigation.
评估在腹主动脉瘤（AAA）腔内隔绝术植入及随访过程中不同超声模式的应用。
1995年2月至1996年5月，18例患者（14例男性；年龄49至80岁，平均67岁）接受了肾下腹主动脉瘤的腔内介入治疗。17例患者接受了米亚尔赫支架型分叉人工血管植入，1例患者因假性动脉瘤接受直管型人工血管治疗。植入过程中及植入后，使用3.25MHz和5MHz环形阵列超声探头经腹观察人工血管。血管内超声与血管造影联合用于术后检查。
术中，经腹二维（2D）超声成功监测导丝从腹股沟进入分叉型人工血管主体以植入第二支。所有植入手术技术上均成功，但术中通过2D超声和血管造影发现4例内漏。1例自行愈合，2例分别在1个月和4个月时接受腔内技术治疗，最后1例漏血因患者在2个月时可能死于心肌梗死而未修复。随访期间，2D超声成功观察到所有人工血管；在长达18个月的监测中未发现内漏。
经腹超声成像在分叉型人工血管植入中对于引导导丝插入以及在连接第二支人工血管至主人工血管之前控制导丝位置可能具有重要价值。如果能获得整个人工血管的满意图像，超声检查可能可以替代血管造影和计算机断层扫描作为随访检查。
