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Background <p>This study aimed to assess the accuracy of aortic measurements obtained by intravascular ultrasound (IVUS) compared with intra-arterial contrast agents (IACA), and to evaluate the role of IVUS in endovascular repair of abdominal aortic aneurysms (EVAR), particularly in patients with chronic kidney disease (CKD).</p> Patients and methods <p>This prospective single-center study which was conducted in vascular surgery departments at Al-Azhar university hospitals from December 2017 to December 2022. It included eighty patients complaining of infrarenal abdominal aortic aneurysm (AAAs). According to treatment policy, patients were divided into two groups: Group A: treated by EVAR with an intra-arterial contrast agent. Group B: treated by EVAR with intravascular ultrasound;</p> Results <p>Receiver operating characteristic (ROC) curve analysis showed that access artery diameter (right or left iliac) measured by IVUS significantly predicted aneurysm sac size reduction after EVAR (AUC = 0.88, <i>P</i> = 0.003). At a cut-off &gt; 14&#xa0;mm, the access artery diameter yielded 100% sensitivity, 80% specificity, positive predictive value (PPV) of 83.3%, and negative predictive value (NPV) of 100%. A moderate agreement was observed between computed tomography angiography (CTA) and IVUS in assessing aortic dimensions. Larger access artery diameters (&gt; 14&#xa0;mm) were associated with less sac regression, possibly due to suboptimal distal sealing and increased risk of type Ib endoleaks.</p> Conclusion <p>IVUS is a valuable and accurate imaging tool compared to CTA for aortic measurements during EVAR, especially beneficial for patients with renal impairment by reducing contrast load and radiation exposure.</p>

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Role of intravascular ultrasound use in patients undergoing endovascular aortoiliac aneurysm repair

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月10日

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  • Mohammed Alsagheer Alhewy,
  • Mohamed Yahia Zakaria Mohamed,
  • Mohamed Hamza Metwaly,
  • Reda Othman Abbas,
  • Ehab Abd Elmoneim Ghazala,
  • Ahmed Atef Khamis,
  • Abdallah Elsayed,
  • Mohammed Ibrahim Hammoda

摘要

Background

This study aimed to assess the accuracy of aortic measurements obtained by intravascular ultrasound (IVUS) compared with intra-arterial contrast agents (IACA), and to evaluate the role of IVUS in endovascular repair of abdominal aortic aneurysms (EVAR), particularly in patients with chronic kidney disease (CKD).

Patients and methods

This prospective single-center study which was conducted in vascular surgery departments at Al-Azhar university hospitals from December 2017 to December 2022. It included eighty patients complaining of infrarenal abdominal aortic aneurysm (AAAs). According to treatment policy, patients were divided into two groups: Group A: treated by EVAR with an intra-arterial contrast agent. Group B: treated by EVAR with intravascular ultrasound;

Results

Receiver operating characteristic (ROC) curve analysis showed that access artery diameter (right or left iliac) measured by IVUS significantly predicted aneurysm sac size reduction after EVAR (AUC = 0.88, P = 0.003). At a cut-off > 14 mm, the access artery diameter yielded 100% sensitivity, 80% specificity, positive predictive value (PPV) of 83.3%, and negative predictive value (NPV) of 100%. A moderate agreement was observed between computed tomography angiography (CTA) and IVUS in assessing aortic dimensions. Larger access artery diameters (> 14 mm) were associated with less sac regression, possibly due to suboptimal distal sealing and increased risk of type Ib endoleaks.

Conclusion

IVUS is a valuable and accurate imaging tool compared to CTA for aortic measurements during EVAR, especially beneficial for patients with renal impairment by reducing contrast load and radiation exposure.