Reducing Angiographic Dependence in Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms Through Intravascular Ultrasound Guidance: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and random-effects meta-analysis compared intravascular ultrasound (IVUS)-guided with conventional angiography-assisted endovascular repair of infrarenal abdominal aortic aneurysms. Six cohort studies included 577 patients, of whom 248 (43%) underwent IVUS-guided repair. IVUS guidance was associated with lower iodine contrast use (mean difference −53.57 mL; 95% CI −61.39 to −45.75), shorter fluoroscopy time, and lower radiation exposure. Early endoleak rates were similar between approaches. The observational evidence suggests IVUS can reduce imaging-related exposures without a detected difference in early endoleaks.

Key findings

• Primary technical success was achieved in 99.8% of IVUS-assisted EVAR procedures.
• IVUS guidance was associated with 53.57 mL less iodine contrast use (95% CI −61.39 to −45.75; P < 0.00001).
• Fluoroscopy time was shorter with IVUS guidance (MD −10.89 min; 95% CI −15.20 to −6.58; P < 0.00001).
• Early endoleak rates were similar: 5.9% with IVUS-guided versus 5.6% with angiography-assisted EVAR (OR 1.02; 95% CI 0.46 to 2.26; P = 0.95).

Why it matters

EVAR relies on imaging to guide device placement, and contrast and radiation exposure are relevant procedural considerations. These pooled cohort findings indicate that IVUS guidance may reduce both iodine contrast use and radiation exposure while maintaining high technical success and similar early endoleak rates. The results help frame IVUS as an alternative imaging approach, while not establishing comparative benefit through randomised evidence.

What to keep in mind

The meta-analysis included six cohort studies, so findings are observational and may be affected by differences between studies or patient selection.