Endovascular ultrasound-guided endoprosthesis implantation for post-traumatic arteriovenous fistulas: overcoming the limitations of angiographic imaging
- 1O. O. Shalimov National Scientific Centre for Surgery and Transplantology, Kyiv
Abstract
Objective. To compare measurements of arterial diameter obtained by digital subtraction angiography and intravascular ultrasound in patients with post-traumatic arteriovenous fistulas of the lower limbs following mine-blast injuries, and to determine the optimal approach to selecting the size of the stent-graft.
Materials and methods. A retrospective analysis was conducted of the diagnostic findings and endovascular treatment of 10 patients (all men aged 27–46 years) with post-traumatic fistulas of the femoral and popliteal arteries resulting from mine-blast injuries. A two-stage imaging protocol was performed intraoperatively: digital subtraction angiography in two projections and intravascular ultrasound with measurement of the diameter along the outer elastic membrane. The size of the stent graft was selected based on the results of the intravascular ultrasound examination, with a target increase of 10–20 per cent. The Wilcoxon test and Bland–Altman analysis were used to compare paired measurements.
Results. The diameter of the target zone, as measured by digital subtraction angiography, ranged from 5.3 to 8.3 mm (median 6.05 mm), whilst that measured by intravascular ultrasound ranged from 6.9 to 10.1 mm (median 7.6 mm). The median difference between the diameters measured by intravascular ultrasound and digital subtraction angiography was 1.75 mm (p = 0.00195; r = 0.98). The mean Bland–Altman bias was 1.66 mm (range 0.79–2.53 mm), equivalent to 1–2 stent-graft sizes. Technical success was achieved in all 10 patients (no endoleak was recorded). There were no vascular complications during the 30-day follow-up period.
Conclusions. In this series of observations, digital subtraction angiography systematically underestimated the diameter of the artery in post-traumatic arteriovenous fistulas of mine-blast origin. The use of intravascular ultrasound, with measurement of the arterial diameter based on the outer elastic membrane as a guide for selecting the stent-graft size, made it possible to avoid the implantation of a prosthesis with an undersized diameter. The technical success rate was 100 per cent. No early complications were observed. Prospective studies involving larger sample sizes are required to definitively confirm the advantages of measuring arterial diameter under intravascular ultrasound guidance for stent-graft sizing.
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BibTeX
@article{vahis2026endovascular,
title = {{Endovascular ultrasound-guided endoprosthesis implantation for post-traumatic arteriovenous fistulas: overcoming the limitations of angiographic imaging}},
author = {Y. H. Vahis and S. M. Furkalo},
journal = {Український журнал клінічної хірургії},
year = {2026},
month = oct,
doi = {10.26779/2786-832x.2026.5.39},
url = {https://doi.org/10.26779/2786-832x.2026.5.39},
note = {CC BY},
}
RIS
TY - JOUR
TI - Endovascular ultrasound-guided endoprosthesis implantation for post-traumatic arteriovenous fistulas: overcoming the limitations of angiographic imaging
AU - Y. H. Vahis
AU - S. M. Furkalo
PY - 2026
DA - 2026/10/23
JO - Український журнал клінічної хірургії
DO - 10.26779/2786-832x.2026.5.39
UR - https://doi.org/10.26779/2786-832x.2026.5.39
AB - Objective. To compare measurements of arterial diameter obtained by digital subtraction angiography and intravascular ultrasound in patients with post-traumatic arteriovenous fistulas of the lower limbs following mine-blast injuries, and to determine the optimal approach to selecting the size of the stent-graft. Materials and methods. A retrospective analysis was conducted of the diagnostic findings and endovascular treatment of 10 patients (all men aged 27–46 years) with post-traumatic fistulas of the femoral and popliteal arteries resulting from mine-blast injuries. A two-stage imaging protocol was performed intraoperatively: digital subtraction angiography in two projections and intravascular ultrasound with measurement of the diameter along the outer elastic membrane. The size of the stent graft was selected based on the results of the intravascular ultrasound examination, with a target increase of 10–20 per cent. The Wilcoxon test and Bland–Altman analysis were used to compare paired measurements. Results. The diameter of the target zone, as measured by digital subtraction angiography, ranged from 5.3 to 8.3 mm (median 6.05 mm), whilst that measured by intravascular ultrasound ranged from 6.9 to 10.1 mm (median 7.6 mm). The median difference between the diameters measured by intravascular ultrasound and digital subtraction angiography was 1.75 mm (p = 0.00195; r = 0.98). The mean Bland–Altman bias was 1.66 mm (range 0.79–2.53 mm), equivalent to 1–2 stent-graft sizes. Technical success was achieved in all 10 patients (no endoleak was recorded). There were no vascular complications during the 30-day follow-up period. Conclusions. In this series of observations, digital subtraction angiography systematically underestimated the diameter of the artery in post-traumatic arteriovenous fistulas of mine-blast origin. The use of intravascular ultrasound, with measurement of the arterial diameter based on the outer elastic membrane as a guide for selecting the stent-graft size, made it possible to avoid the implantation of a prosthesis with an undersized diameter. The technical success rate was 100 per cent. No early complications were observed. Prospective studies involving larger sample sizes are required to definitively confirm the advantages of measuring arterial diameter under intravascular ultrasound guidance for stent-graft sizing.
SN - 2786-832X
SN - 2786-8311
ER -