ULTRASOUND-BASED QUANTIFICATION OF EMBOLI DURING CONVENTIONAL AND ENDOVASCULAR ANEURYSM REPAIR

Purpose: To differentiate and quantify the type and number of lower li mb emboli occurring during endovascular aneurysm repair, as compared t o conventional surgery. Methods: Thirty-eight patients underwent elect ive infrarenal aneurysm repair using a conventional surgical approach in 18 and an endovascular procedure in 20. Emboli were detected using a Doppler ultrasound system with a 2-MHz transducer interrogating the mid superficial femoral artery. Lower limb emboli were differentiated as particulate or gaseous based on the physical distance traversed by the embolic signal. Results: Significantly more particulate (median 10 8 versus 59, p = 0.015) and gaseous (134 versus 46, p = 0.008) emboli were detected during endovascular aneurysm repair as compared to conve ntional surgery. Clinically, no case of massive microembolization occu rred in either group, but one patient in the conventional group requir ed a femoral embolectomy, and three patients undergoing endovascular r epair developed self-limiting trash feet postoperatively. In patients undergoing endovascular aortomonoiliac aneurysm repair, there was only a poor correlation between the number of particulate emboli and eithe r procedural duration or operator experience. Conclusions: The apparen t lack of a relationship between particulate embolization and operativ e time or technical experience suggests that manipulation of endolumin al devices within the aneurysm sac may not be the sole determinant of intraprocedural embolization. Other as yet undetermined factors may pr edict patients at high risk for massive embolization.