INTRODUCTIONDespite the patient and medical staff exposure to radiation in endovascular
aneurysm repair, the benefits of this abdominal aortic aneurysm type of
surgical management are justfied by minor recovery time and hospitalization,
as well as an option for patients not elected to conventional open repair.
In this minimally invasive surgical aproach, time of procedure and radiation
doses can be substantial - and the increasing frequency of these procedures
and it's complexity have impelled vascular surgeons to face additional and
successive risk to occupational radiation exposure. Meticulous study of the
computed tomography angiography during the endovascular aneurysm repair
preparation allows reduction of unnecessary radiation exposure, as also
reduces consecutive image acquisition and contrast use (that may be related
to renal overload in susceptible patients). Some studies have proposed
strategies to optimize endovascular intervention to reduce contrast use and
X-ray exposure. Although they might prove to be effective, they rely on use
of additional specific and advanced equipment, available only in major
centers. As an alternative to this expensive and restrict technology, it is
presented a simpler technique through image manipulation on software OsiriX,
aiming to reduce both exposures.OBJECTIVETo analyze the efficacy of the adoption of a study protocol and a
script-based guide in preparation for endovascular aneurysm repair through
verifying it's impact over the surgical procedure - as referred to
intravascular contrast infuse, effects over renal function, blood loss and
operatory time.METHODSA longitudinal prospective study from March 2014 through March 2015, where 30
performed endovascular aneurysm repair were compared to a historic control
group. The planning for endovascular aneurysm repair through the patient's
tomographic image manipulation in the prospective group was performed with
OsiriX MD software. A script-based guide upon gathering detailed computed
tomography angiography images was elaborated by the author and distributed
to the performing surgical team for appreciation, instruction and pre
operatory judgment. Based upon the script, the C-arm gantry angle was
specifically corrected in each case of endovascular aneurysm repair, for
image optimization and aneurysm's neck visualization. Arteriography was
performed under digital subtraction angiography after catheters were
positioned according to predicted level description in the referred guide.
Statistical analysis were performed with a significance level of 5%
(P value<0.05).RESULTSThere was a statistically significant relationship between the two studied
periods and the variables: contrast volume (284.5 vs. 31.8
mL), operative time (207.5 vs. 140.4 min.) and blood loss
(798.1 vs. 204.4 mL), revealing that they are considerably
larger in the historical control group than in the script guided current
group. There was no difference related to the volume of contrast used in the
two groups and the occurrence of renal impairment.CONCLUSIONIn the ...
