Download PDF
CC BY 4.0 · Aorta (Stamford) 2022; 10(01): 003-012
DOI: 10.1055/s-0042-1743107
State-of-the-Art Review

Transesophageal Ultrasound Guidance for Endovascular Interventions on the Aorta

Mireya Castro-Verdes 
1   Department of Echocardiography and Paediatric Cardiology, Royal Brompton and Harefield, National Health Service (NHS) Foundation Trust, London, United Kingdom
,
Xun Yuan 
2   Department of Cardiology and Aortic Centre, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
3   National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
,
Andreas Mitsis 
4   Department of Cardiology, Nicosia General Hospital, Strovolos, Cyprus
,
Wei Li
5   Department of Echocardiography and Congenital Heart Disease, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
,
Christoph A. Nienaber
2   Department of Cardiology and Aortic Centre, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
3   National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Aortic pathologies in general require a multidisciplinary approach and decision-making to integrate elements of clinical acuity, vascular pathology, individual comorbidity, and risk assessment; thus, ideally it is a center with access to multiple imaging modalities and expertise in all treatment options. Besides classic open surgical options, endovascular procedures have been accepted for a variety of aortic pathologies. More recently, novel transcatheter interventions even to the proximal aorta have been introduced, particularly for patients unfit for open surgery. Nevertheless, the role of transesophageal echocardiography to guide percutaneous aortic interventions is not well established, notwithstanding the growing potential as an ancillary tool to guide the procedure and document success.

Keywords

transesophageal echocardiogram - aorta - percutaneous intervention - aortic dissection - thoracic endovascular aortic repair


Publication History

Received: 18 April 2021

Accepted: 30 August 2021

Article published online:
31 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Erbel R, Aboyans V, Boileau C. et al; ESC Committee for Practice Guidelines, The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35 (41) 2873-2926
    CrossrefPubMedGoogle Scholar
  • 2 Yuan X, Mitsis A, Semple T. et al. False lumen intervention to promote remodelling and thrombosis-the FLIRT concept in aortic dissection. Catheter Cardiovasc Interv 2018; 92 (04) 732-740
    CrossrefPubMedGoogle Scholar
  • 3 Evangelista A, Flachskampf FA, Erbel R. et al; European Association of Echocardiography, Document Reviewers. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 2010; 11 (08) 645-658
    CrossrefPubMedGoogle Scholar
  • 4 Goldstein SA, Evangelista A, Abbara S. et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2015; 28 (02) 119-182
    CrossrefPubMedGoogle Scholar
  • 5 Bhave NM, Nienaber CA, Clough RE, Eagle KA. Multimodality imaging of thoracic aortic diseases in adults. JACC Cardiovasc Imaging 2018; 11 (06) 902-919
    CrossrefPubMedGoogle Scholar
  • 6 Evangelista A, Maldonado G, Gruosso D. et al. The current role of echocardiography in acute aortic syndrome. Echo Res Pract 2019; 6 (02) R53-R63
    CrossrefPubMedGoogle Scholar
  • 7 Silvestry FE, Kerber RE, Brook MM. et al. Echocardiography-guided interventions. J Am Soc Echocardiogr 2009; 22 (03) 213-231 , quiz 316–317
    CrossrefPubMedGoogle Scholar
  • 8 Koschyk DH, Nienaber CA, Knap M. et al. How to guide stent-graft implantation in type B aortic dissection? Comparison of angiography, transesophageal echocardiography, and intravascular ultrasound. Circulation 2005; 112 (9, Suppl): I260-I264
    CrossrefPubMedGoogle Scholar
  • 9 Nienaber CA, Sakalihasan N, Clough RE. et al. Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: ready for a broader application?. J Thorac Cardiovasc Surg 2017; 153 (02) S3-S11
    CrossrefPubMedGoogle Scholar
  • 10 Badano LP, Aruta P, Nguyen K. et al. Principali applicazioni dell'ecocardiografia tridimensionale nell'attuale pratica clinica. [Current clinical applications of three-dimensional echocardiography] G Ital Cardiol (Rome) 2019; 20 (12) 722-735
    PubMedGoogle Scholar
  • 11 Tan W, Aboulhosn J. Echocardiographic guidance of interventions in adults with congenital heart defects. Cardiovasc Diagn Ther 2019; 9 (Suppl. 02) S346-S359
    CrossrefPubMedGoogle Scholar
  • 12 Faletra FF, Pedrazzini G, Pasotti E. et al. 3D TEE during catheter-based interventions. JACC Cardiovasc Imaging 2014; 7 (03) 292-308
    CrossrefPubMedGoogle Scholar
  • 13 Nienaber CA, Clough RE, Sakalihasan N. et al. Aortic dissection. Nat Rev Dis Primers 2016; 2: 16071
    CrossrefPubMedGoogle Scholar
  • 14 Fattori R, Cao P, De Rango P. et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol 2013; 61 (16) 1661-1678
    CrossrefPubMedGoogle Scholar
  • 15 Evangelista A, Avegliano G, Aguilar R. et al. Impact of contrast-enhanced echocardiography on the diagnostic algorithm of acute aortic dissection. Eur Heart J 2010; 31 (04) 472-479
    CrossrefPubMedGoogle Scholar
  • 16 Thorsgard ME, Morrissette GJ, Sun B. et al. Impact of intraoperative transesophageal echocardiography on acute type-A aortic dissection. J Cardiothorac Vasc Anesth 2014; 28 (05) 1203-1207
    CrossrefPubMedGoogle Scholar
  • 17 Bossone E, Evangelista A, Isselbacher E. et al; International Registry of Acute Aortic Dissection Investigators. Prognostic role of transesophageal echocardiography in acute type A aortic dissection. Am Heart J 2007; 153 (06) 1013-1020
    CrossrefPubMedGoogle Scholar
  • 18 Patil TA, Nierich A. Transesophageal echocardiography evaluation of the thoracic aorta. Ann Card Anaesth 2016; 19 (Supplement): S44-S55
    CrossrefPubMedGoogle Scholar
  • 19 Moral S, Avegliano G, Cuéllar H. et al. Usefulness of transesophageal echocardiography in the evaluation of celiac trunk and superior mesenteric artery involvement in acute aortic dissection. J Am Soc Echocardiogr 2020; 34 (04) 327-335
    CrossrefPubMedGoogle Scholar
  • 20 Evangelista A, Aguilar R, Cuellar H. et al. Usefulness of real-time three-dimensional transoesophageal echocardiography in the assessment of chronic aortic dissection. Eur J Echocardiogr 2011; 12 (04) 272-277
    CrossrefPubMedGoogle Scholar
  • 21 Sasaki S, Watanabe H, Shibayama K. et al. Three-dimensional transesophageal echocardiographic evaluation of coronary involvement in patients with acute type A aortic dissection. J Am Soc Echocardiogr 2013; 26 (08) 837-845
    CrossrefPubMedGoogle Scholar
  • 22 Yuan X, Mitsis A, Ghonem M, Iakovakis I, Nienaber CA. Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection. J Vis Surg 2018; 4: 59
    CrossrefPubMedGoogle Scholar
  • 23 Grabenwöger M, Alfonso F, Bachet J. et al. Thoracic endovascular aortic repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2012; 33 (13) 1558-1563
    CrossrefPubMedGoogle Scholar
  • 24 Chen Y, Zhang S, Liu L, Lu Q, Zhang T, Jing Z. Retrograde type A aortic dissection after thoracic endovascular aortic repair: a systematic review and meta-analysis. J Am Heart Assoc 2017; 6 (09) e004649
    CrossrefPubMedGoogle Scholar
  • 25 Moon MC, Greenberg RK, Morales JP. et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg 2011; 53 (04) 942-949
    CrossrefPubMedGoogle Scholar
  • 26 Sobocinski J, O'Brien N, Maurel B. et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur J Vasc Endovasc Surg 2011; 42 (04) 442-447
    CrossrefPubMedGoogle Scholar
  • 27 Mehmedovic A, Konstantinou N, Jerkku T. et al. Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?. [Aortic Aneurysm: Fenestrated/Branched Endovascular Aortic Repair (EVAR) and Fenestrated/Branched Thoracic Endovascular Aortic Repair (TEVAR). Is Total Endovascular Repair Already Here?] Zentralbl Chir 2020; 145 (05) 432-437
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Evangelista A, Maldonado G, Moral S. et al. Intramural hematoma and penetrating ulcer in the descending aorta: differences and similarities. Ann Cardiothorac Surg 2019; 8 (04) 456-470
    CrossrefPubMedGoogle Scholar
  • 29 Moral S, Cuéllar H, Avegliano G. et al. Clinical implications of focal intimal disruption in patients with type B intramural hematoma. J Am Coll Cardiol 2017; 69 (01) 28-39
    CrossrefPubMedGoogle Scholar
  • 30 Evangelista A, Czerny M, Nienaber C. et al. Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer. Eur J Cardiothorac Surg 2015; 47 (02) 209-217
    CrossrefPubMedGoogle Scholar
  • 31 Baumgartner H, De Backer J, Babu-Narayan SV. et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42 (06) 563-645
    CrossrefPubMedGoogle Scholar
  • 32 Salcher M, Naci H, Law TJ, Kuehne T, Schubert S, Kelm M. Cardioproof Consortium. Balloon dilatation and stenting for aortic coarctation: a systematic review and meta-analysis. Circ Cardiovasc Interv 2016; 9 (06) e003153
    CrossrefPubMedGoogle Scholar
  • 33 Pericas P, Noris Mora M, Fernández-Palomeque C, Massot Rubio M, Grau Sepulveda A, Peral Disdier V. Aortic coarctation endarteritis: the importance of a systematic echocardiographic study. J Cardiol Cases 2017; 17 (02) 56-58
    CrossrefPubMedGoogle Scholar
  • 34 Stern H, Erbel R, Schreiner G, Henkel B, Meyer J. Coarctation of the aorta: quantitative analysis by transesophageal echocardiography. Echocardiography 1987; 4: 387-395
    CrossrefPubMedGoogle Scholar
  • 35 Cheung YF, Leung MP, Lee J, Yung TC. An evolving role of transesophageal echocardiography for the monitoring of interventional catheterization in children. Clin Cardiol 1999; 22 (12) 804-810
    CrossrefPubMedGoogle Scholar
  • 36 Evangelista A, Salas A, Ribera A. et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation 2012; 125 (25) 3133-3141
    CrossrefPubMedGoogle Scholar
  • 37 Yuan X, Mitsis A, Mozalbat D, Nienaber CA. Novel endovascular management of proximal type A (DeBakey II) aortic dissection with a patent foramen ovale occluder. J Endovasc Ther 2017; 24 (06) 809-813
    CrossrefPubMedGoogle Scholar
  • 38 Yuan X, Nienaber C. Aortic imaging and biomechanics in Marfan syndrome: keep it simple but not too simple. Eur Heart J 2019; 40 (25) 2055-2057
    CrossrefPubMedGoogle Scholar
  • 39 Akin I, Kische S, Rehders TC. et al. Current role of endovascular therapy in Marfan patients with previous aortic surgery. Vasc Health Risk Manag 2008; 4 (01) 59-66
    CrossrefPubMedGoogle Scholar
  • 40 Yuan X, Mitsis A, Nienaber CA. Novel reconstruction of a vascular aneurysm in Marfan syndrome. J Vis Surg 2018; 4: 67
    CrossrefPubMedGoogle Scholar
  • 41 Castro Verdes M, Yuan X, Li W, Senior R, Nienaber CA. Aortic intervention guided by contrast-enhanced transoesophageal ultrasound whist waiting for cardiac transplantation: a case report. Eur Heart J Case Rep 2020; 5 (01) a485
    CrossrefPubMedGoogle Scholar
  • 42 Agricola E, Slavich M, Rinaldi E. et al. Usefulness of contrast-enhanced transoesophageal echocardiography to guide thoracic endovascular aortic repair procedure. Eur Heart J Cardiovasc Imaging 2016; 17 (01) 67-75
    PubMedGoogle Scholar
  • 43 Ho D, Squelch A, Sun Z. Modelling of aortic aneurysm and aortic dissection through 3D printing. J Med Radiat Sci 2017; 64 (01) 10-17
    CrossrefPubMedGoogle Scholar
  • 44 Barral PA, Demasi-Jacquier MA, Bal L. et al. Fusion imaging to guide thoracic endovascular aortic repair (TEVAR): a randomized comparison of two methods, 2D/3D versus 3D/3D image fusion. Cardiovasc Intervent Radiol 2019; 42 (11) 1522-1529
    CrossrefPubMedGoogle Scholar
  • 45 Freitas-Ferraz AB, Rodés-Cabau J, Junquera Vega L. et al. Transesophageal echocardiography complications associated with interventional cardiology procedures. Am Heart J 2020; 221: 19-28
    CrossrefPubMedGoogle Scholar
  • 46 Hahn RT, Abraham T, Adams MS. et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26 (09) 921-964
    CrossrefPubMedGoogle Scholar