ULTRASOUND IMAGING DURING ENDOVASCULAR ABDOMINAL AORTIC-ANEURYSM REPAIR USING THE STENTOR BIFURCATED ENDOGRAFT

Purpose: To evaluate different ultrasound modalities during implantati on and follow-up of endovascular grafts for abdominal aortic aneurysm (AAA) exclusion.Methods: Between February 1995 and May 1996, 18 patien ts (14 men; aged 49 to 80 years, mean 67) were treated with endovascul ar intervention for infrarenal AAA. Seventeen patients received Mialhe Stenter bifurcated grafts, while one patient was treated with a strai ght graft for pseudoaneurysm. During and after the implantation, 3.25- and 5-MHz annular array ultrasound probes were used for transabdomina l visualization of the endograft. Intravascular ultrasound was applied in combination with angiography for postoperative control. Results: I ntraprocedurally, transabdominal two-dimensional (2D) ultrasound succe ssfully monitored guidewire passage from the groin into the main part of the bifurcated endograft far implantation of the second limb. All i mplantation procedures were technically successful, but four endoleaks were identified intraprocedurally by 2D ultrasound and angiography. O ne healed spontaneously, two were treated with endovascular techniques at 1 and 4 months, and the last leak was scheduled far repair when th e patient died of probable myocardial infarction at 2 months. During f ollow-up, 2D ultrasound successfully visualized all the endografts; no endoleaks were found in up to 18 months of surveillance. Conclusions: Transabdominal ultrasound imaging could be valuable in bifurcated end ograft deployment both for guiding guidewire insertion and for control ling wire position before the second graft limb is connected to the ma in graft. Provided that satisfactory visualization of the entire endog raft can be obtained, ultrasound examination may possibly replace art artiography and computed tomographic scanning as a follow-up investiga tion.