Abstract
BACKGROUND: This study aimed to assess the accuracy of aortic measurements obtained by intravascular ultrasound (IVUS) compared with intra-arterial contrast agents (IACA), and to evaluate the role of IVUS in endovascular repair of abdominal aortic aneurysms (EVAR), particularly in patients with chronic kidney disease (CKD). PATIENTS AND METHODS: This prospective single-center study which was conducted in vascular surgery departments at Al-Azhar university hospitals from December 2017 to December 2022. It included eighty patients complaining of infrarenal abdominal aortic aneurysm (AAAs). According to treatment policy, patients were divided into two groups: Group A: treated by EVAR with an intra-arterial contrast agent. Group B: treated by EVAR with intravascular ultrasound; RESULTS: Receiver operating characteristic (ROC) curve analysis showed that access artery diameter (right or left iliac) measured by IVUS significantly predicted aneurysm sac size reduction after EVAR (AUC = 0.88, P = 0.003). At a cut-off > 14 mm, the access artery diameter yielded 100% sensitivity, 80% specificity, positive predictive value (PPV) of 83.3%, and negative predictive value (NPV) of 100%. A moderate agreement was observed between computed tomography angiography (CTA) and IVUS in assessing aortic dimensions. Larger access artery diameters (> 14 mm) were associated with less sac regression, possibly due to suboptimal distal sealing and increased risk of type Ib endoleaks. CONCLUSION: IVUS is a valuable and accurate imaging tool compared to CTA for aortic measurements during EVAR, especially beneficial for patients with renal impairment by reducing contrast load and radiation exposure.