to evaluate the role of intravascular ultrasound (IVUS) for the technical assessment of kissing stents (KS) and covered endovascular reconstruction of the aortic bifurcation (CERAB) in the treatment of aortoiliac obstructive disease involving the aortic bifurcation. We conducted a single-center retrospective review of patients undergoing endovascular treatment of severe aorto-iliac obstructive disease (2019-2023). IVUS was performed in patients treated by KS or CERAB according to preoperative indications, in cases of moderate/severe calcifications, mural thrombus, total occlusions, and lesion extension towards the proximity of renal or hypogastric arteries. Indications for IVUS-guided intraoperative revisions were residual stenosis or compression >30%, incomplete stent-to-wall apposition, or flow-limiting dissection at the landing site. Follow-up assessment was performed at 6, 12 months, and then yearly. Thirty-days outcomes and two-year patency rates were evaluated. Logistic regression was used to identify factors associated with significant technical defects detected by IVUS needing intraoperative revision. IVUS was used for the technical assessment of 102 patients treated by KS (n=57, 56%) or CERAB (n=45, 44%) presenting with severe intermittent claudication (39%), rest pain (39%), or ischemic tissue loss (25%). Twenty-nine significant technical defects were identified by IVUS in 25 patients (25%) who then had successful intraoperative correction by additional ballooning (n=23, 80%) or stenting (n=6, 20%). Patients with a severely calcified chronic total occlusion (OR 1.85, 95%CI 1.01-5.27; P=.044) or severely calcified narrow aortic bifurcation with <12 mm diameter (OR 2.34, 95%CI 1.10-8.64; P=.032) were at increased risk for IVUS-guided intraoperative revision. There were no post-operative deaths and no major adverse events. Two-year primary patency was 100%. IVUS was used for the technical assessment of KS/CERAB in a selected cohort of patients with severe aorto-iliac obstructive disease. This allowed the identification and intraoperative correction of a significant technical defect not detected by completion angiogram in 1/4 of patients, achieving optimal two-year results. IVUS assessment of KS/CERAB may be considered especially in patients with a calcified total occlusion or narrow aortic bifurcation.

中文翻译：

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血管内超声在主动脉分叉血管内重建技术评估中的作用

评估血管内超声（IVUS）在对吻支架（KS）和主动脉分叉覆盖血管内重建（CERAB）技术评估中在涉及主动脉分叉的主动脉髂阻塞性疾病治疗中的作用。我们对接受血管内治疗的严重主髂动脉阻塞性疾病患者（2019-2023）进行了单中心回顾性评价。对于接受KS或CERAB治疗的患者，根据术前适应症，对中度/重度钙化、附壁血栓、完全闭塞以及病变向肾动脉或腹下动脉附近扩展的病例进行IVUS。IVUS 引导的术中翻修的适应症是残余狭窄或压缩 >30%、支架与壁贴合不完整或着陆部位限流解剖。随访评估在第 6、12 个月进行，然后每年进行一次。评估了三十天的结果和两年的通畅率。使用逻辑回归来识别与 IVUS 检测到的需要术中修复的重大技术缺陷相关的因素。IVUS 用于对 102 名接受 KS (n=57, 56%) 或 CERAB (n=45, 44%) 治疗的患者进行技术评估，这些患者出现严重间歇性跛行 (39%)、静息痛 (39%) 或缺血性症状组织损失（25%）。IVUS 在 25 名患者 (25%) 中发现了 29 个重大技术缺陷，然后通过额外球囊扩张 (n=23, 80%) 或支架置入术 (n=6, 20%) 成功进行了术中矫正。患有严重钙化慢性完全闭塞（OR 1.85，95%CI 1.01-5.27；P=.044）或严重钙化狭窄主动脉分叉且直径<12毫米（OR 2.34，95%CI 1.10-8.64；P=.032）的患者）进行 IVUS 引导的术中翻修的风险增加。无术后死亡，也无重大不良事件。两年一期通畅率为 100%。IVUS 用于对选定的患有严重主动脉-髂动脉阻塞性疾病的患者队列进行 KS/CERAB 技术评估。这使得 1/4 的患者能够识别和术中纠正完成血管造影未检测到的重大技术缺陷，从而实现最佳的两年结果。特别是对于钙化完全闭塞或主动脉分叉狭窄的患者，可以考虑对 KS/CERAB 进行 IVUS 评估。