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When echocardiography fails, intravascular ultrasound as an alternative for adequate graft patency in hybrid elephant trunk surgery


1 Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
2 Department of Anesthesiology, Mayo Clinic Health System, Minnesota, USA
3 Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
4 Anesthesiology Institute, Cleveland Clinic; Department of Cardiothoracic Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA

Correspondence Address:
Tomas Carvajal
Department of Anesthesiology, Mayo Clinic Health System, 1025 Marsh St, Mankato, MN 56001
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_131_20

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Year : 2021  |  Volume : 24  |  Issue : 4  |  Page : 495-497

 

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Aortic pathology is a common cardiovascular disease in the US. Transesophageal Echocardiogram is an invaluable imaging modality in the management of aortic pathology in perioperative setting. Intravascular ultrasound can assess coronary obstruction during coronary interventions and can be used in endovascular aneurysm repair. A 54-year-old male underwent Hybrid Elephant Trunk Surgery, for complex open aorta repair. There was functional confirmation graft patency via the femoral arterial line tracing, there was surgical confirmation via visual and physical inspection of graft, but there was lacking anatomical confirmation. Epiaortic ultrasound reassured the graft patency at level of the arch. However, transesophageal echocardiogram was not reassuring for adequate anatomical confirmation of patency. Intravascular ultrasound was used for anatomical confirmation of graft patency and position. This technology provides real time graft patency and is a great tool in open aorta reconstruction surgery.






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1 Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
2 Department of Anesthesiology, Mayo Clinic Health System, Minnesota, USA
3 Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
4 Anesthesiology Institute, Cleveland Clinic; Department of Cardiothoracic Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA

Correspondence Address:
Tomas Carvajal
Department of Anesthesiology, Mayo Clinic Health System, 1025 Marsh St, Mankato, MN 56001
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_131_20

Rights and Permissions

Aortic pathology is a common cardiovascular disease in the US. Transesophageal Echocardiogram is an invaluable imaging modality in the management of aortic pathology in perioperative setting. Intravascular ultrasound can assess coronary obstruction during coronary interventions and can be used in endovascular aneurysm repair. A 54-year-old male underwent Hybrid Elephant Trunk Surgery, for complex open aorta repair. There was functional confirmation graft patency via the femoral arterial line tracing, there was surgical confirmation via visual and physical inspection of graft, but there was lacking anatomical confirmation. Epiaortic ultrasound reassured the graft patency at level of the arch. However, transesophageal echocardiogram was not reassuring for adequate anatomical confirmation of patency. Intravascular ultrasound was used for anatomical confirmation of graft patency and position. This technology provides real time graft patency and is a great tool in open aorta reconstruction surgery.






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