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Comparing Aortic Graft Sizing Between IVUS And CTA For BTAI Patients Undergoing TEVAR
Nicholas Schaper, Alec Falkenhain, Tyler Arismendi, Matthew R. Smeds, MD, Saideep Bose, MD, MPH.
Saint Louis University, St. Louis, MO, USA.

OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) is preferred treatment for severe blunt thoracic aortic injuries (BTAIs). Successful outcomes rely on accurate endograft sizing, but there is concern that initial imaging may underestimate aortic diameters. This study examines the impact of intravascular ultrasound (IVUS) on endograft sizing and postoperative clinical outcomes in BTAI patients.
METHODS: A prospectively collected multi-institutional dataset from the Aortic Trauma Foundation was analyzed. Patients with BTAI undergoing TEVAR with IVUS were compared to patients who underwent TEVAR alone. Demographics and operative variables were compared, focusing on IVUS effects on endograft sizing as determined by examining maximal proximal/distal aortic luminal diameter on initial CT imaging compared to the proximal/distal aortic graft diameter of the TEVAR.
RESULTS: 293 patients (78.2% male) with average age of 42.7 (17.2) underwent TEVAR for BTAI with IVUS performed in 124 (42.3%). The average Injury Severity Score (ISS) was 32.2 (14.3), with no significant difference between the two groups (p=0.914). In-hospital mortality was similar between the two groups (p=0.581). Of these, 5 IVUS and 12 non-IVUS patients died from aortic-related causes. There was no difference in reintervention after TEVAR (p=1.000) or type 1 endoleak (p=0.677). The average difference between aortic graft diameter and aortic luminal diameter (ΔD) on CTA were 4.17 mm (5.9) IVUS and 4.50 mm (4.3) non-IVUS distally (p=0.606) and 4.32 mm (4.8) IVUS and 4.23 mm (3.9) non-IVUS proximally (p=0.859). When considering blunt injury mechanisms, IVUS was used more frequently for motor vehicle collision (p<0.001) but less frequently for falls or motorcycle accidents (p<0.05). IVUS use was more frequent in patients with lower pre-operative creatinine (p<0.05); and postoperative hemoglobin was lower in patients who had IVUS (p<0.05). Cerebrovascular accidents occurred less frequently in patients who had IVUS (p<0.05). CONCLUSIONS: Utilization of IVUS is not associated with a significant change in endograft sizing compared to sizing based on CT scan alone in patients with BTAI. IVUS use was not associated with differences in in-hospital mortality but was associated with a significant decrease in cerebrovascular complications. Routine IVUS use in BTAI patients may not be necessary for endograft sizing.


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