Author + information
- Received April 2, 2014
- Revision received July 1, 2014
- Accepted July 3, 2014
- Published online August 1, 2015.
- Eustachio Agricola, MD∗∗ (, )
- Massimo Slavich, MD∗,
- Luca Bertoglio, MD†,
- Efrem Civilini, MD†,
- Germano Melissano, MD†,
- Enrico Marone, MD†,
- Enrico Rinaldi, MD†,
- Andrea Fisicaro, MD∗,
- Claudia Marini, MD∗,
- Vincenzo Tufaro, MD∗,
- Alberto Margonato, MD∗ and
- Roberto Chiesa, MD†
- ∗Division of NonInvasive Cardiology, San Raffaele Hospital, Milan, Italy
- †Division of Vascular Surgery, San Raffaele Hospital, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Eustachio Agricola, Division of Noninvasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy.
Thoracic endovascular aortic repair (tevar) is commonly performed in selected patients to treat thoracic aortic pathologies. Transesophageal echocardiography (TEE) is often used as adjunct to fluoroscopy and angiography (ANGIO) during TEVAR, mainly reducing radiation exposure and contrast load. Contrast TEE (cTEE) has been shown to be feasible and reliable in the diagnostic workup of acute aortic syndromes, providing additional morphological and functional information compared with standard TEE. Endoleak occurrence after TEVAR remains one of the principal limitations of this procedure because mainly type I endoleak could increase the rupture rates of degenerative aneurysms and negatively affect the long-term results of endovascular treatment of type B aortic dissections. Studies have demonstrated that in patients undergoing endovascular abdominal aortic repair, contrast ultrasound has a greater sensitivity for endoleak detection during follow-up than standard ultrasound and has diagnostic value similar to that of computed tomography angiography (CTA) and magnetic resonance. We investigated the use of cTEE in the setting of TEVAR. cTEE provided additional contributions, both in the preoperative characterization of the aortic pathology (identification of number and sites of tears and aneurysmal thrombosis) and in the intraprocedural and immediate post-procedural assessment (slow flow and/or remaining flow in a false lumen or aneurysmal sac, the presence and classification of persistent leaks, and detection of new intimal tears after stent deployment) (Figures 1 to 4⇓⇓⇓⇓).
Therefore, our experience suggests that adding cTEE to TEE and ANGIO provides relevant information in all steps of TEVAR, from disease characterization to deployment and the post-procedural assessment, improving the procedural outcomes.
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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 2, 2014.
- Revision received July 1, 2014.
- Accepted July 3, 2014.
- American College of Cardiology Foundation