I use IVUS when I place
endografts and have found it helpful and reliable. I do not call our vascular
techs in, however, and run the system myself with my co-operator, one of our
interventional radiologists. I haven't done a huge number, about two dozen
cases, but we have generally found it helpful pre- and post-placement. There is
some literature on the topic as well:
coworkers compared IVUS to uniplanar angiography in the aorta, iliac, and
femoral arteries and found that IVUS was accurate. Similarly, Sheikh and coworkers compared
IVUS to conventional Duplex color-flow ultrasound, 2-D transcutaneous
ultrasound, and digital angiography.
IVUS compared well to the other three modalities in terms of lumen
diameter (r=0.91-0.98) and cross-sectional area (r=0.92-0.97). In addition, both studies comment that
IVUS provides additional information about the location and characteristics of
plaque, not provided by other modalities.
A number of studies have suggested that plaque characteristics may relate
to the success of coronary angioplasty.
A good review of the topic by Korogi et al has been
coworkers from Harbor-UCLA
Center compared CT
scans and IVUS in an experimental canine model before and after endovascular
graft placement. The average
difference between the two modalities was 0.17 ± 0.92
mm. IVUS measurements were slightly
larger than CT measurements: 8.84 ± 1.0
compared to 8.65 ± 1.1 mm
(p<0.03) but there was good correlation with linear regression (r=0.948,
p<0.02). However, qualitative
assessments of the endovascular graft (folding, stent-aorta interfaces,
thrombus) were more accurate with IVUS.
The full report is highly
colleagues compared IVUS to CTA.
IVUS correctly identified 31 of 32 renal arteries and 4 of 5 accessory
renal arteries. IVUS tended to
underestimate the length compared to CTA (0.48 ± 0.52 cm; p < .001). Compared to Verbin's study, however,
these authors determined that IVUS
tended to underestimate diameter (0.68 ± 1.76; p = .006). However, these authors did find that
interobserver variances were minimal (r = 1.0).
coworkers also demonstrated the usefulness of IVUS during endovascular graft
deployment in a dog model. These
authors positioned the endovascular graft initially with fluoroscopy and then
replaced the guidewire with an IVUS catheter for real-time observation of
deployment. IVUS was useful in
determining vessel size, graft position, and proper deployment against the
I will send references in a
separate post since Flownet has been rejecting my post because of
Michael A. Ricci, MD
Professor of Surgery
University of Vermont College of Medicine
Vice President for Clinical
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