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Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers.
Ann Vasc Surg. 2020 Jul 04 [Online ahead of print]AV

Abstract

BACKGROUND

Penetrating aortic ulcer (PAU) is an atherosclerotic lesion penetrating the elastic lamina and extending into the media of the aorta. It may evolve into intramural hematoma, focal dissection, pseudoaneurysm, and eventually rupture. The purpose of this study was to evaluate the effectiveness of a totally intravascular ultrasound (IVUS)-assisted endovascular exclusion of PAU.

METHODS

Thirteen consecutive patients (median age 66 years) underwent IVUS-assisted endovascular exclusion of PAU. The primary end points were fluoroscopy time, radiation dose, and occurrence of type I primary endoleak. Secondary end points were postoperative mortality and morbidity, arterial access complications, postoperative length of stay in the hospital, and occurrence of type II endoleaks.

RESULTS

The median fluoroscopy time was 4 min (4-5). The median radiation dose was 4.2 mGy (3.9-4.5). A proximal and distal landing zone of at least 2 cm could be obtained in all the patients. No patient presented a type I endoleak. No postoperative mortality, no morbidity, or arterial access complication was observed. The median length of postoperative stay in the hospital was 2 days (2-3). The median length of follow-up was 25 months (9.2-38.7). One late type II endoleak was observed (7.7%), because of reflux from the intercostal arteries, without the need for additional treatment.

CONCLUSIONS

IVUS-assisted endovascular treatment of PAU allows durable exclusion of PAU with a short fluoroscopy time and no need for injection of contrast media. Further series are needed to confirm the results of this preliminary study.

Authors+Show Affiliations

Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy. Electronic address: giulio.illuminati@uniroma1.it.Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.Department of Vascular Surgery, Sant'Anna Hospital, Catanzaro, Italy.Department of Clinical Research, University Hospital of Poitiers, Poitiers, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32634558

Citation

Illuminati, Giulio, et al. "Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers." Annals of Vascular Surgery, 2020.
Illuminati G, Pasqua R, Nardi P, et al. Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers. Ann Vasc Surg. 2020.
Illuminati, G., Pasqua, R., Nardi, P., Fratini, C., Calio, F. G., & Ricco, J. B. (2020). Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers. Annals of Vascular Surgery. https://doi.org/10.1016/j.avsg.2020.06.059
Illuminati G, et al. Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers. Ann Vasc Surg. 2020 Jul 4; PubMed PMID: 32634558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers. AU - Illuminati,Giulio, AU - Pasqua,Rocco, AU - Nardi,Priscilla, AU - Fratini,Chiara, AU - Calio,Francesco G, AU - Ricco,Jean-Baptiste, Y1 - 2020/07/04/ PY - 2020/06/01/received PY - 2020/06/22/revised PY - 2020/06/23/accepted PY - 2020/7/8/pubmed PY - 2020/7/8/medline PY - 2020/7/8/entrez JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - BACKGROUND: Penetrating aortic ulcer (PAU) is an atherosclerotic lesion penetrating the elastic lamina and extending into the media of the aorta. It may evolve into intramural hematoma, focal dissection, pseudoaneurysm, and eventually rupture. The purpose of this study was to evaluate the effectiveness of a totally intravascular ultrasound (IVUS)-assisted endovascular exclusion of PAU. METHODS: Thirteen consecutive patients (median age 66 years) underwent IVUS-assisted endovascular exclusion of PAU. The primary end points were fluoroscopy time, radiation dose, and occurrence of type I primary endoleak. Secondary end points were postoperative mortality and morbidity, arterial access complications, postoperative length of stay in the hospital, and occurrence of type II endoleaks. RESULTS: The median fluoroscopy time was 4 min (4-5). The median radiation dose was 4.2 mGy (3.9-4.5). A proximal and distal landing zone of at least 2 cm could be obtained in all the patients. No patient presented a type I endoleak. No postoperative mortality, no morbidity, or arterial access complication was observed. The median length of postoperative stay in the hospital was 2 days (2-3). The median length of follow-up was 25 months (9.2-38.7). One late type II endoleak was observed (7.7%), because of reflux from the intercostal arteries, without the need for additional treatment. CONCLUSIONS: IVUS-assisted endovascular treatment of PAU allows durable exclusion of PAU with a short fluoroscopy time and no need for injection of contrast media. Further series are needed to confirm the results of this preliminary study. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/32634558/Intravascular_Ultrasound-Assisted_Endovascular_Exclusion_of_Penetrating_Aortic_Ulcers L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(20)30561-6 DB - PRIME DP - Unbound Medicine ER -
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