Abstract 1835: Intraluminal Ultrasonography Depicts Detailed Pathology in Type B Aortic Dissection and Safely Guides Emergency Fenestration
Background: Transesophageal echocardiography (TEE) and conventional intravascular ultrasound (IVUS) have limited capabilities in aortic dissection. intraluminal phased-array imaging (IPAI) was compared with IVUS and TEE to evaluate the diagnostic value of IPAI in type B aortic dissection.
Methods: In 23 patients with type B aortic dissection, IPAI was tested with respect to its ability to depict true and false lumen (TL, FL), to localize which abdominal arteries originate from the TL and FL, and to identify all entries (E) and reentries. After completion of TEE, two additional examiners performed angiography and positioned an AcuNav-catheter (AC) inside the TL using a long access sheath (AS). An IVUS-catheter was then introduced into the TL by a fourth examiner. All examiners were blinded to each other. Four additional patients with type B aortic dissection developed peripheral malperfusion due to true lumen collapse. Transvenous IPAI from the inferior vena cava was employed to guide emergency fenestration of the intimal flap using a Brockenbrough-needle.
Results: TL and FL could be equally well identified by all diagnostic methods. IPAI detected more E than IVUS (3.0±1.2 vs. 0.8±0.5; p<0.001) and thoracic IPAI depicted more E than TEE (1.8±1.0 vs. 1.2±0.5; p<0.001). Both IPAI and IVUS showed >90% of the abdominal side branches. In all patients with peripheral malperfusion, successful emergency intimal flap fenestration was safely guided by IPAI.
Conclusions: In the detailed diagnostic evaluation of type B aortic dissection, IPAI is superior to conventional IVUS and TEE. IPAI is also very useful for guiding emergency intimal flap fenestration.