3D vascular imaging with power mode in planning and controlling percutaneously implanted abdominal aortic stent grafts

Objective: Evaluation of the reliability of vascular ultrasound with power mode and 3D-power mode for preinterventional planning before endovascular treatment of abdominal aortic aneurysms and postoperative follow-up after endografting.

Methods: A new real-time 3D technique with power mode flow imaging was used in a prospective study of 75 patients with infrarenal aortic aneurysms, in 25 cases before and in 50 cases after stentgraft implantation. The results of vascular ultrasound with color-coded duplex sonography (CCDS), power mode and 3D power mode were compared with CTA and DSA in all cases.

Results: Only the length and diameter of the aneurysm could be reliably measured by sonography. Additional 3D reconstructions could show flow parameters in the aneurysm more clearly, but imaging of the proximal and distal anchoring zone was only achieved insufficiently. After stentgraft implantation, possible complications like thrombus formation in the graft (4/50) and endoleaks (15/50) were clearly seen by power sonography. 9 anchoring leaks and 6 side-branch endoleaks were found. 3D power mode made localizing and imaging of aneurysm reperfusion easier. Detection of the origin of side-branch endoleaks was achieved only by DSA. Stent frame fractures (4/50) were difficult to see by ultrasound.

Conclusions: Vascular ultrasound with power mode and 3D power mode makes the imaging of complications after endoaortic stentgraft implantation like endoluminal thrombus formation or endoleaks and the documentation of aneurysm reperfusion easier compared to CCDS. 3D reconstructions show the dimensions of the aneurysm but are not able to substitute CTA and DSA with measuring catheter for preinterventional planning.