European Journal of Vascular & Endovascular Surgery
Volume 17, Issue 1 , Pages 22-27, January 1999

Intraoperative Transoesophageal Echocardiography as an Adjuvant to Fluoroscopy during Endovascular Thoracic Aortic Repair

  • D.M Moskowitz

      Affiliations

    • Department of Anaesthesiology, The Mount Sinai Medical Center, New York, NY, U.S.A.
    • ,
  • R.A Kahn

      Affiliations

    • Department of Anaesthesiology, The Mount Sinai Medical Center, New York, NY, U.S.A.
    • ,
  • S.N Konstadt

      Affiliations

    • Department of Anaesthesiology, The Mount Sinai Medical Center, New York, NY, U.S.A.
    • ,
  • H Mitty

      Affiliations

    • Department of Radiology, The Mount Sinai Medical Center, New York, NY, U.S.A.
    • ,
  • L.H Hollier

      Affiliations

    • Department of Surgery, The Mount Sinai Medical Center, New York, NY, U.S.A.
    • ,
  • M.L Marin

      Affiliations

    • Department of Surgery, The Mount Sinai Medical Center, New York, NY, U.S.A.

Accepted 27 May 1998.

Article Outline

Abstract 

Objectives:to define the utility of intraoperative transeophageal echocardiography (TEE) during endovascular thoracic aortic repair.Design:retrospective study.Materials:five patients underwent six transluminal endovascular stent-graft procedures for repair of thoracic aortic disease.Methods:after induction of anaesthesia, a multiplane or biplane TEE probe was placed to obtain views of the diseased aorta. Both transverse and longitudinal planes of the aortic arch and descending thoracic aortic segments were imaged. The aortic pathology was confirmed by TEE and the proximal and distal extents of the intrathoracic lesion were defined. Doppler and colour-flow imaging was used to identify flow patterns through the aorta before and after stent-graft deployment.Results:visualisation and confirmation of the aortic pathology by ultrasonography was accomplished in all patients. TEE was able to confirm proper placement of the endograft relative to the aortic lesion after deployment and was able to confirm exclusion of blood flow into the aneurysm sacs.Conclusions:TEE may facilitate repair by confirming aortic pathology, identifying endograft placement, assessment of the adequacy of aneurysm sack isolation, as well as dynamic intraoperative cardiac assessment.

Keywords: Endovascular, Thoracic aneurysms, Transoesophageal echocardiography.

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. McNamara JJ, Presslar VM. Natural history of arteriosclerotic thoracic aortic aneurysms. Ann Thorac Surg. 1978;26:468–473
  2. Bickerstaff LK, Pairolero PC, Hollier LH. Thoracic aortic aneurysms: a population-based study. Surgery. 1982;92:1103–1108
  3. Coselli JS, Figueiredo LF. Natural history of descending and thoracoabdominal aortic aneurysms. J Card Surg. 1997;12:289–289
  4. Hollier LH, Symmonds JB, Pairolero PC. Thoracoabdominal aortic aneurysm repair. Analysis of postoperative morbidity. Arch Surg. 1988;123:871–875
  5. Cambria RP, Brewster DC, Moncure AC. Recent experience with thoracoabdominal aortic aneurysm repair. Arch Surg. 1989;124:620–624
  6. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331:1729–1734
  7. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–499
  8. Marin ML, Veith FS, Panetta TF. Transfemoral endoluminal stent graft repair of a popliteal artery aneurysm. J Vasc Surg. 1994;19:754–757
  9. Marin ML, Veith FJ, Lyon RT, Cynamon J. Transfemoral endovascular repair of iliac artery aneurysm. Am J Surg. 1995;170:179–182
  10. Marin ML, Veith FJ, Sanchez LA. Endovascular aorto-iliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia. J Vasc Surg. 1995;22:316–322
  11. Marin ML, Veith FJ, Panetta TP. Transluminally placed endovascular stented grafts for repair of arterial trauma. J Vasc Surg. 1994;20:466–473
  12. Mitchell RS, Dake MD, Semba CP. Endovascular stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 1996;111:1054–1062
  13. Yusuf SW, Whitaker SC, Chuter TAM. Early results of endovascular aortic aneurysm surgery with aortoiliac graft, contralateral iliac occlusion, and femorofemoral bypass. J Vasc Surg. 1997;25:165–172
  14. Blum U, Voshage G, Lammer J. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med. 1997;336:13–20
  15. Marin ML, Veith FJ, Cynamon J. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesion. Ann Surg. 1995;222:449–469
  16. Parodi JC. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg. 1995;21:549–555
  17. May J, White G, Waugh RC, Yu W, Harris JP. Treatment of complex abdominal aortic aneurysms and other arterial lesions. J Vasc Surg. 1994;19:924–933
  18. van Essen JA, van der Lugt A, Gussenhoven EJ. Intravascular ultrasonography allows accurate assessment of abdominal aortic aneurysm: anin vitro. J Vasc Surg. 1998;27:347–353
  19. White R, Donayre C, Walot I. Endograft repair of an aortic pseudoaneurysm following gunshot wound injury: impact of imaging on diagnosis and planning of intervention. J Endovasc Surg. 1997;4:344–351
  20. Verbin C, Scoccianti M, Kopchok G. Comparison of the utility of CT scans and intravasular ultrasound in endovascular aortic grafting. Ann Vasc Surg. 1995;9:434–440
  21. Konstadt SN, Reich DL, Quintana C. The ascending aorta: how much does the transesophageal echocardiography see?. Anesth Analg. 1994;78:240–244
  22. Bansal RC, Chandrasekaran K, Ayala K. Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. JACC. 1995;25:1393–1401
  • f1 Please address all correspondence to: D. Moskowitz, Department of Anaesthesiology, Box 1010, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY, U.S.A.

PII: S1078-5884(98)90661-X

doi:10.1053/ejvs.1998.0661

European Journal of Vascular & Endovascular Surgery
Volume 17, Issue 1 , Pages 22-27, January 1999

Article Tools