Feasability of contrast-enhanced ultrasound with image fusion of CEUS and MS-CT for endovascular grafting in infrarenal abdominal aortic aneurysm in a single patient

Issue title: Selected papers of the 18th European Conference for Clinical Hemorheology and Microcirculation (ESCHM), 5-8 June, 2016, Lisbon, Portugal

Article type: Research Article

Authors: Zimmermann, H.^* | Rübenthaler, J. | Paprottka, P. | Paprottka, K.J. | Reiser, M. | Clevert, D.A.

Affiliations: Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany

Correspondence: [*] Corresponding author: Hanna Zimmermann, Institute of Clinical Radiology, Interdisciplinary Ultrasound Center,University Hospitals Munich – Campus Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15,81377 Munich, Germany. Tel.: +49 89 4400 73620; Fax: +49 89 4400 78832; E-mail: [email protected].

Abstract: Currently methods to reduce radiation and contrast media application in endovascular repair of aortic aneurysms (EVAR) are investigated. First positive results for real-time contrast medium–enhanced ultrasonography (CEUS) guided endovascular aortic repair have been reported. A combination with image fusion of CEUS and preoperative multi-slice computed tomography (MS-CT) might offer added safety regarding stent-graft positioning and sealing of the landing zones. EVAR was performed in a patient with an asymptomatic infrarenal aortic aneurysm and a penetrating aortic ulcer in the neck region. The precise placement of the stent-graft was performed with CEUS using image fusion and native intraprocedural angiographic fluoroscopy and confirmed with digital subtraction angiography (DSA) using iondinated contrast media. At follow-up, CEUS was used to exclude endoleaks and stent-graft failure or malposition. The precise CEUS-guided placement of the stent-graft was technically successful. No artifacts due to electrical noise and metallic parts of the operating table and surgical instruments occurred. The amount of iodinated contrast media was reduced as intraoperative follow-up was performed using CEUS. CEUS with image fusion combined with intraprocedural angiographic fluoroscopy enables accurate stent-graft placement without use of any nephrotoxic contrast media. This allows EVAR in patients with renal insufficiency or allergic reactions to contrast media.

DOI: 10.3233/CH-168045

Journal: Clinical Hemorheology and Microcirculation, vol. 64, no. 4, pp. 711-719, 2016