CTA with Fluoroscopy Image Fusion Guidance in Endovascular Complex Aortic Aneurysm Repair

Sailer, Anna M.; Haan, Michiel W. de; Peppelenbosch, A.G.; Jacobs, Michael J.; Wildberger, Joachim E.; Schurink, Geert Willem H.

doi:10.1016/j.ejvs.2013.12.022

Cited by 88 publications

(43 citation statements)

References 10 publications

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“…Similar results were reported by another group who evaluated fenestrated and branched endografts [13]. Iodinated contrast material volume and procedural time were significantly lower in the fusion group than in case controls (159 versus 199 mL and 5.2 versus 6.3 h, respectively).…”

Section: Clinical Applications and Review Of The Literaturesupporting

confidence: 87%

“…Potential pitfalls are inappropriate matching of CT volume and fluoroscopy, leading to misregistration. Respiration-related and cardiac cycle-related vessel displacement, vessel elongation, and displacement by stiff devices and patient movement have been identified as reasons for fusion image inaccuracy [13]. The insertion of rigid (stent) delivery systems into the vascular system can significantly alter the anatomical relations due to "stretching out" of the vessels.…”

Section: Clinical Applications and Review Of The Literaturementioning

confidence: 99%

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Update on New Tools for Three-dimensional Navigation in Endovascular Procedures

Berg

2014

aorta

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Three-dimensional (3D) guidance for endovascular procedures has developed over the last decade from 3D rotational angiography to the use of dynamic 3D roadmap techniques. The latest development is image merging. This technique combines real-time feedback of fluoroscopy with optimal soft-tissue contrast of previously performed computed tomography (CT) or magnetic resonance angiography. Merging of CT angiography and cone-beam CT/fluoroscopic images is feasible, and preliminary results look promising. Merging will allow us to further reduce radiation exposure, contrast dose, and procedural time, and its main use and benefit will be in complex endovascular interventions.

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Section: Clinical Applications and Review Of The Literaturesupporting

confidence: 87%

Section: Clinical Applications and Review Of The Literaturementioning

confidence: 99%

Update on New Tools for Three-dimensional Navigation in Endovascular Procedures

Berg

2014

aorta

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“…The relationship with extension of the aneurysm has been reported previously, and is most likely related to the coverage of the aorta and corresponding spinal cord blood supply. 7 However, the effects of the contrast volume seem to reflect something beyond the technical experience and adjunctive imaging techniques as this was statistically significant between the two time periods, as opposed to SCI incidence which did not reach significance. 14,15 Furthermore, experimental studies have suggested the possibility for these collateral networks to compensate for the hemodynamic changes within 5 days of segmental occlusion.…”

Section: Discussionmentioning

confidence: 89%

“…7 Arterial access was obtained from the right axillary artery and both femoral arteries. Iodine contrast was routinely used, except for SMA and celiac trunk visualization where CO 2 was used.…”

Section: Introductionmentioning

confidence: 99%

Short-term Outcome of Spinal Cord Ischemia after Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Dias

Sonesson

Kristmundsson

et al. 2015

European Journal of Vascular and Endovascular Surgery

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eTAAA has low peri-operative mortality, but SCI incidence is high albeit that it decreased with increasing experience. More extensive repair and use of larger volumes of contrast were associated with higher risk of SCI. Acute repair does not significantly increase SCI risk. A standardized protocol for early diagnosis and treatment of SCI leads to a higher recovery rate with a greater likelihood of regaining ambulatory capacity.

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“…Optionally, one can consider using 3D CT image fusion to reduce the number of DSA runs, especially in complex fenestrated and branched EVAR. 22,23 …”

Section: Discussionmentioning

confidence: 99%

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

et al. 2017

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Purpose: To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. Methods: A retrospective analysis was performed of 74 EVAR procedures, including 16,889 X-ray runs using fixed C-arm imaging equipment. Four multivariate log-linear mixed models (with patient as a random effect) were constructed. Mean air kerma DR (DRAK, mGy/s) and the mean dose area product DR (DRDAP, mGycm2/s) were the outcome variables utilized for fluoroscopy as differentiated from digital subtraction angiography (DSA). These models were used to predict the maximum radiation duration allowed before a 2-Gy skin threshold (for DRAK) or a 500-Gycm2 threshold (for DRDAP) was reached. Results: The strongest predictor of DRAK and DRDAP for fluoroscopy imaging was the radiation protocol, with an increase of 200% when changing from “low” to “medium” and 410% from “low” to “normal.” The strongest predictors of DRAK and DRDAP for DSA were C-arm angulation, with an increase of 47% per 30° of angulation, and body mass index (BMI), with an increase of 58% for every 5-point increase in BMI. Based on these models, a patient with a BMI of 30 kg/m2, combined with 45° of rotation and a field size of 800 cm2 in the medium fluoroscopy protocol has a predicted DRAK of 0.39 mGy/s (or 85.5 minutes until the 2-Gy skin threshold is reached). While using comparable settings but switching the acquisition to a DSA with a “2 frames per second” protocol, the predicted DRAK will be 6.6 mGy/s (or 5.0 minutes until the 2-Gy threshold is reached). Conclusion: X-ray radiation DRs are constantly fluctuating during and between patients based on BMI, the protocols, C-arm position, and the image acquisitions that are used. An instant patient risk chart visualizes these radiation dose fluctuations and provides an overview of the expected duration of X-ray radiation, which can be used to predict when follow-up dose thresholds are reached during abdominal endovascular procedures.

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CTA with Fluoroscopy Image Fusion Guidance in Endovascular Complex Aortic Aneurysm Repair

Abstract: Image fusion guidance provides added value in complex endovascular interventions. The technology significantly reduces iodinated contrast material dose and procedure time.

Cited by 88 publications

References 10 publications

Update on New Tools for Three-dimensional Navigation in Endovascular Procedures

Update on New Tools for Three-dimensional Navigation in Endovascular Procedures

Short-term Outcome of Spinal Cord Ischemia after Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

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