Value of Intravascular Phased-Array Probe in Diagnostics and Treatment of Aortic Dissection

Two clinical cases of the aortic dissection (DeBakey III) endovascular treatment with intravascular phased-array probe use are presented. Literature review is given as well. The disease was diagnosed by the aorta, iliac arteries, and lower extremities arteries ultrasound examination, computed tomography, and aortography. Aortic endovascular fenestration under intravascular ultrasound control was performed. Ultrasound investigation was performed using Acuson Sequoia 512 scanner (Siemens, Germany) equipped with the intravascular phased-array probe AcuNav applying B-mode, colour Doppler, and pulsed Doppler. Intravascular ultrasound allowed assessing hemodynamics in the true and false lumen of aorta and its branches during the aortic endovascular fenestration. Intravascular ultrasound allowed showing that endovascular fenestration makes the blood flow speed in the true aortic lumen equal to the false one. In conclusion, intravascular ultrasound allowed assessing hemodynamics before, during, and after the aortic fenestration and estimate fenestration efficacy.

внутрисосудистое ультразвуковое исследование, внутрисосудистый катетерный датчик с фазированной решеткой, аортография, расслоение аорты, эндоваскулярное вмешательство, фенестрация, intravascular ultrasound, intravascular phased-array probe, aortography, aortic dissection, endovascular treatment, fenestration

1. Parker M.S., Matheson T.L., Rao A.V. et al. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries // Am. J. Roentgenol. 2001. V. 176. No. 5. P. 1267-1272.

2. Agarwal P.P., Chughtai A., Matzinger F.R., Kazerooni E.A. Multidetector CT of thoracic aortic aneurysms // Radiographics. 2009. V. 29. No. 2. P. 537-552.

3. Litmanovich D., Bankier A.A., Cantin L. et al. CT and MRI in diseases of the aorta // Am. J. Roentgenol. 2009. V. 193. No. 4. P. 928-940.

4. Holloway B.J., Rosewarne D., Jones R.G. Imaging of thoracic aortic disease // Br. J. Radiol. 2011. V. 84. No. 3. P. S338-S354.

5. Erbel R., Borner N., Steller D. et al. Detection of aortic dissection by transoesophageal echocardiography // Br. Heart J. 1987. V. 58. No. 1. P. 45-51.

6. Evangelista A., Garcia-del-Castillo H., Gonzalez-Alujas T. et al. Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts // J. Am. Coll. Cardiol. 1996. V. 27. No. 1. P. 102-107.

7. Flachskampf F.A., Badano L., Daniel W.G. et al. Recommendations for transoesophageal echocardiography: update 2010 // Eur. J. Echocardiogr. 2010. V. 11. No. 7. P. 557-576.

8. Gorge G., Erbel R. Intravascular ultrasound for monitoring percutaneous fenestration of a membrane from an aortic dissection // Dtsch. Med. Wochen schr. 1996. V. 121. No. 51-51. P. 1598-1602.

9. Trerotola S.O. Use of a stone basket as a target during fenestration of aortic dissection // J. Vasc. Interv. Radiol. 1996. V. 7. No. 5. P. 687-690.

10. Slonim S.M., Nyman U., Semba C.P. et al. Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration // J. Vasc. Surg. 1996. V. 23. No. 2. P. 241-251.

11. Williams D.M., Lee D.Y., Hamilton B.H. et al. The dissected aorta: percutaneous treatment of ischemic complications - principles and results // J. Vasc. Interv. Radiol. 1997. V. 8. No. 4. P. 605-665.

12. Lee D.Y., Williams D.M., Abrams G.D. The dissected aorta: part II. Differentiation of the true from the false lumen with intravascular US // Radiology. 1997. V. 203. No. 1. P. 32-36.

13. Koschyk D.H., Meinertz T., Hofmann T. et al. Value of intravascular ultrasound for endovascular stentgraft placement in aortic dissection and aneurysm // J. Card. Surg. 2003. V. 18. No. 5. P. 471-477.

14. Koschyk D.H., Nienaber C.A., Knap M. et al. How to guide stent-graft implantation in type B aortic dissection? Comparison of angiography, transesophageal echocardiography, and intravascular ultrasound // Circulation. 2005. V. 112. No. 9. Suppl. P. I260-I264.

15. Pearce B.J., Jordan W.D. Jr. Using IVUS during EVAR and TEVAR: improving patient outcomes // Semin. Vasc. Surg. 2009. V. 22. No. 3. P. 172-180.

16. DiMusto P.D., Williams D.M., Himanshu H.J. et al. Endovascular management of type B aortic dissections // J. Vasc. Surg. 2010. V. 52. No. 4. Suppl. P. 26S-36S.

17. Bartel T., Eggebrecht H., Muller S. et al. Comparison of diagnostic and therapeutic value of transesophageal echocardiography, intravascular ultrasonic imaging, and intraluminal phased-array imaging in aortic dissection with tear in the descending thoracic aorta (type B) // Am. J. Cardiol. 2007. V. 99. No. 2. P. 270-274.

18. Kimoto S., Omoto R., Tsunemoto M. Ultrasonic tomography of the liver and detection of heart atrial septal defect with the aid of ultrasonic intravenous probes // Ultrasonics. 1964. V. 2. No. 2. P. 82-86.

19. Klinicheskoe rukovodstvo po ul'trazvukovoi diagnostike. T. 1 / Pod red. V.V. Mit'kova. M.: Vidar, 1996. 336 s.

20. Tsvibel' V.D., Pellerito D.S. Ul'trazvukovoe issledovanie sosudov / Per. s angl. pod red. V.V. Mit'kova. M.: Vidar, 2008. 646 s.

21. Hijazi Z.M., Shivakumar K., Sahn D.J. Intracardiac echocardiography during interventional and electrophysiological cardiac catheterization // Circulation. 2009. V. 119. No. 4. P. 587-596.

22. Hijazi Z., Wang Z., Cao Q. et al. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography // Cathet. Cardiovasc. Interv. 2001. V. 52. No. 2. P. 194-199.

23. Amin Z. Transcatheter closure of secundum atrial septal defects // Cathet. Cardiovasc. Interv. 2006. V. 68. No. 5. P. 778-787.

24. Cao Q.L., Zabal C., Koenig P. et al. Initial clinical experience with intracardiac echocardiography in guiding transcatheter closure of perimembranous ventricular septal defects: feasibility and comparison with transesophageal echocardiography // Cathet. Cardiovasc. Interv. 2005. V. 66. No. 2. P. 258-267.

25. Silvestry F.E., Kerber R.E., Brook M.M. et al. Echocardiography-guided interventions // J. Am. Soc. Echocardiogr. 2009. V. 2. No. 3. P. 213-231.

26. Bartel T., Eggebrecht H., Ebradlidze T. et al. Images in cardiovascular medicine. Optimal guidance for intimal flap fenestration in aortic dissectio by transvenous two-dimensional and Doppler ultrasonography // Circulation. 2003. V. 107. No. 2. P. e17-e18.

27. Swaminathan M., Lineberger C.K., McCann R.L., Mathew J.P. The importance of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic aneurysms // Anesth. Analg. 2003. V. 97. No. 6. P. 1566-1572.

28. Eriksson M.O., Nyman R. The value of intravascular phased-array imaging in endovascular treatment of thoracic aortic pathology // Acta Radiol. 2011. V. 52. No. 3. P. 285-290.

29. Weintraub A.R., Erbel R., Gorge G. et al. Intravascular ultrasound imaging in acute aortic dissection // J. Am. Coll. Cardiol. 1994. V. 24. No. 2. P. 495-503.

30. Yamada E., Matsumura M., Kyo S., Omoto R. Usefulness of a prototype intravascular ultrasound imaging in evaluation of aortic dissection and comparison with angiographic study, transesophageal echocardiography, computed tomography, and magnetic resonance imaging // Am. J. Cardiol. 1995. V. 75. No. 2. P. 161-165.

31. Alfonso F., Goicolea J., Aragoncillo P. et al. Diagnosis of aortic intramural hematoma by intravascular ultrasound imaging // Am. J. Cardiol. 1995. V. 76. No. 10. P. 735-738.

32. Erbel R., Alfonso F., Boileau C. et al. Diagnosis and management of aortic dissection // Eur. Heart J. 2001. V. 22. No. 18. P. 1642-1681.

33. Erbel R., Aboyans V., Boileau C. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) // Eur. Heart J. 2014. V. 35. No. 41. P. 2873-2926.

34. Fattori R., Botta L., Lovato L. et al. Malperfusion syndrome in type B aortic dissection: role of the endovascular procedures // Acta Chir. Belg. 2008. V. 108. No. 2. P. 192-197.