Jacques Kpodonu, MD, Venkatesh G. Ramaiah, MD, Edward B. Diethrich, MD

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Presentation transcript:

Intravascular Ultrasound Imaging as Applied to the Aorta: A New Tool for the Cardiovascular Surgeon Jacques Kpodonu, MD, Venkatesh G. Ramaiah, MD, Edward B. Diethrich, MD The Annals of Thoracic Surgery Volume 86, Issue 4, Pages 1391-1398 (October 2008) DOI: 10.1016/j.athoracsur.2008.06.057 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Intravascular ultrasound 0.035 PV catheter system. (PIM Connector = patient interface module connector; TIP O.D. = tip outer diameter of probe.) The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intravascular ultrasound used to calculate area and percentage of stenosis flow by dividing the lumen diameter by vessel diameter. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Intravascular ultrasound image demonstrates distal aortic neck without any thrombus and (B) renal vein crossing the aorta (arrow). The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Intravascular ultrasound demonstrates an abdominal aortic aneurysm with thrombus in wall. (B) Intravascular ultrasound image used to assess of size common iliac artery to determine eligibility for endoluminal graft. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Intravascular ultrasound demonstrates a thoracic aortic aneurysm in an axial view and a longitudinal view demonstrates a conical proximal neck, aneurysm and a distal aortic neck minimal thrombus is seen on the axial and longitudinal views. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Intravascular ultrasound image demonstrates distal neck of thoracic aortic aneurysm with no demonstrable thrombus adequate site for distal fixation of endograft. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 (A) Intravascular ultrasound demonstrating a common iliac artery measuring 8.5 mm with no thrombus and mild calcification amenable to deployment of a stent graft. (B) Intravascular ultrasound used to determine diameter of the proximal neck of a thoracic aortic aneurysm to determine proximal landing zone for endovascular management of thoracic aneurysms. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Intravascular ultrasound demonstrates a type B dissection with a dissecting flap separating a compressed true lumen. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 9 (A) Angiogram in a patient with a type B dissection with renal malperfusion as a result of branch vessel dissection (B) confirmed with intravascular ultrasound. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 10 (A) Angiogram post stent deployment with lumen expansion with improvement in renal flow confirmed with (B) Intravascular ultrasound that demonstrates an increased renal lumen diameter with demonstration of a well apposed renal stent. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 11 Intravascular ultrasound demonstrating a coarctation of the thoracic aorta with a post-stenotic dilatation. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 12 Intravascular ultrasound post stent deployment to treat a primary coarctation of the thoracic aorta demonstrating an increase in luminal gain. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 13 (A) Computed tomographic scan demonstrates a penetrating aortic ulcer of the descending thoracic aorta with contained rupture. (B) Intravascular ultrasound image demonstrates a break in the intima of the descending thoracic aorta compatible with a penetrating aortic ulcer. The Annals of Thoracic Surgery 2008 86, 1391-1398DOI: (10.1016/j.athoracsur.2008.06.057) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions