Intravascular Ultrasound Impact on Endovascular Treatment of Type B Aortic Dissection: A Single-Center Retrospective Study

Abstract

Background: Intravascular ultrasound (IVUS) has numerous applications for the treatment of patients with type B aortic dissections (TBADs). The aim of this study was to analyze the eventual benefits of the use of IVUS in the endovascular treatment of TBAD.

Methods: Patients who underwent endovascular surgery for TBAD in our department from January 2015 to January 2024 were included in the study. Results for patients who had intraoperative IVUS (group A, 38 patients) were compared with those of patients who had no IVUS (group B, 37 patients). The use of IVUS or not depended on the surgeon's personal choice. Primary outcomes included technical success, defined as correct release into the true lumen, and clinical success. Secondary outcomes were complication rates, reintervention rates, and mortality. The mean follow-up time was 37.5 months (range, 1-108 months).

Results: During the analyzed period, 75 patients were treated for TBAD: 19 patients were treated in the acute phase, 41 in the subacute phase and 15 in the chronic phase. Technical success was achieved in 69 patients (92%), with a technical success rate of 100% in group A and of 83.8% in group B (P < 0.0115). Adjunctive intraoperative procedures were required in 6 cases (8%). No intraoperative or 24-hr deaths were recorded. Perioperative aorta-related complications were recorded in 7 cases, and perioperative aorta-related reinterventions were recorded in 6 cases. A 30-day death was recorded in 2 cases. Thirty-day complications were recorded in 4 cases and reinterventions were needed in 5 cases.

Conclusion: The results of our study show the importance of IVUS utilization during endovascular treatment of TBAD, including the accurate positioning of the graft, reduced complication, and reintervention rates.