January 2024News

JGH is first hospital in Quebec to use ultrasound imaging in vascular surgery

IVUS technology shown to improve safety and accuracy of surgical procedures

For the first time in Quebec, vascular surgeons at the JGH are using a type of ultrasound imaging that allows the interior of blood vessels to be viewed with heightened clarity to improve the precision with which surgical procedures are performed.

Until now, the conventional method of examining a patient’s vascular system has been to inject the relevant vessels with a special dye whose dark shading makes those vessels more easily visible in an angiogram (a type of x-ray).

A high-resolution screen (also shown in the photo at the top of this page) displays images and other data about one of the patient’s blood vessels. At the top right is the IVUS image of the interior of an artery, with reddish-orange shading that indicates blood flow. On the left is an angiogram (a type of x-ray) of the same artery. {Click on the image to enlarge it.)

A high-resolution screen (also shown in the photo at the top of this page) displays images and other data about one of the patient’s blood vessels. At the top right is the IVUS image of the interior of an artery, with reddish-orange shading that indicates blood flow. On the left is an angiogram (a type of x-ray) of the same artery. {Click on the image to enlarge it.)

The new technology, known as intravascular ultrasound (IVUS), consists of a long, thin catheter with an ultrasound probe at its tip. It is inserted into an artery in the patient’s circulatory system and is guided to the appropriate location in the body.

The other end of the catheter is connected to computerized ultrasound equipment and to a large, high-resolution screen that displays IVUS images, along with angiograms and other medical data.

Once the IVUS has provided the surgeons with the information they need, the ultrasound probe is withdrawn. Then surgical instruments are guided by the catheter to the spot in the circulatory system where treatment needs to be administered.

The new technology, known as intravascular ultrasound (IVUS), was introduced at the JGH in late 2023 with the considerable support of Dr. Daniel Obrand, JGH Chief of Vascular Surgery. The backing of a private donor, through the JGH Foundation, was instrumental in the acquisition of the technology.

“When the IVUS device is turned on, the ultrasound gives us something we haven’t really had before—a fantastic view of the blood vessels from within,” says Dr. Elie Girsowicz.

“When the IVUS device is turned on, the ultrasound gives us a fantastic view of the blood vessels from within.”

As a vascular surgeon at the JGH, Dr. Girowicz performs arterial repairs and uses minimally invasive techniques to deploy stents and balloons to widen arteries or veins that have narrowed or become obstructed.

Dr. Girsowicz—who is Director of the Vascular Surgery Residency Program at the JGH and an Assistant Professor at McGill University—explains that the IVUS has been used for some time by cardiac surgeons and by cardiologists who are treating patients who have had a heart attack. However, only relatively recently has the technology been adapted for procedures involving the peripheral blood vessels.

Being able to view the interior of specific vessels enables surgeons to clearly understand the nature of the problem and to better assess the condition of those vessels before an operation, Dr. Girsowicz says.

Sometimes, he adds, intravascular ultrasound is also used at the conclusion of the procedure to allow the surgeons to verify that their work was performed without complications—for instance, to be certain that a newly implanted stent is fully open and has not become bent or deformed.

In addition, Dr. Girsowicz cites a study showing that the IVUS improves the surgeons’ ability to choose the most suitable tools, since the technology yields data that is often more accurate than what is obtained when x-rays and contrasting dye are used.

For example, he says, a conventional assessment might lead surgeons to conclude that the diameter of a certain blood vessel is five millimetres—as opposed to the IVUS, which reveals the actual diameter to be six millimetres.

JGH Foundation provided crucial support for IVUS technology

Surgery using intravascular ultrasound would not have beeen possible at the JGH without essential support from the JGH Foundation.

Donations can be made online to support any of the JGH’s programs and services.

“If you decide to use a balloon, it has to be the proper size for that specific blood vessel,” he continues. “If all you have is a 2D image that incorrectly estimates the diameter at five millimetres instead of six, you’ll end up using a balloon that’s undersized for that particular vessel.”

A further advantage of the IVUS, Dr. Girsowicz says, is its usefulness in treating diseases and pathologies of the aorta, the main artery that supplies oxygenated blood to the circulatory system.

If, for example, surgeons need to repair a leaking aorta, the exact source of the leak can sometimes be difficult to identify—a task that is accomplished with greater speed and efficiency with the help of the IVUS.

“Our ongoing goal is to find better ways of ensuring the patient’s safety, based on more accurate information,” Dr. Girsowicz says. “The IVUS technology has clearly shown it’s capable of helping us achieve that goal.”

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