Intravascular ultrasound with a vector phased-array probe (acunav) is feasible in endovascular abdominal aortic aneurysm repair

Background: The ideal imaging method for endovascular aneurysm repair (EVAR) should provide all data regarding diagnosis, measurements, and guiding of stent-graft deployment. Contrast-enhanced computed tomography (CT) is used for preoperative EVAR planning, together with intraoperative angiography. However, the administered contrast volume might result in contrast-induced nephropathy (CIN). Purpose: To develop a technique for aortic measurements, vessel wall evaluation, and stent-graft positioning by using a vector phased-array intravascular ultrasound probe with color Doppler function (AcuNav) in elective EVAR. Material and Methods: Thirteen elective EVAR patients were included. AcuNav was compared to pre- and postoperative CT examinations, perioperative angiography, and postoperative duplex. Results: Measurements for stent-graft sizing were easily obtained and facilitated by the color Doppler function and corresponded well with CT and angiography. The combined information from AcuNav and fluoroscopy provided exact positioning of the stent graft. An aortic placement of the probe provided superior imaging results compared to an inferior vena cava approach. Detection of endoleak was found to be difficult. No complications were registered. Conclusion: The use of AcuNav combined with fluoroscopy in EVAR was found to be safe, effective, and feasible in planning and guiding EVAR procedures. Best results were seen with the probe placed in the artery. AcuNav might be used to replace contrast-enhanced CT and angiography, hence reducing the risk of CIN, especially in high-risk patients.