Fusion Imaging for EVAR with Mobile C-arm

Kaladji, Adrien; Villena, Alexandre; Pascot, Remy; Lalys, Florent; Daoudal, Anne; Clochard, Elodie; Lucas, Antoine; Cardon, Alain

doi:10.1016/j.avsg.2018.06.006

Cited by 16 publications

(19 citation statements)

References 27 publications

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“…Although heterogeneous (Q=30.6, p<0.001; I 2 =80%), the forest plot shows an estimated pooled MD with a significant difference in contrast volume of −29 mL (95% CI −40.5 to −18.5, p<0.001) after image fusion compared with no image fusion. 4,6,[17][18][19]21 The results of the hospital cohort (-6 mL, 95% CI −28.3 to 16.5, p=0.67) are comparable to Hiraoka et al, 18 which had the lowest MD among the meta-analyzed studies (-13 mL, 95% CI −22.1 to −3.50, p=0.009) in standard EVAR.…”

Section: Contrast Volumesupporting

confidence: 69%

“…Overall, a statistically significant difference was found in fluoroscopy time between the image fusion group and control group for complex EVAR (5 studies) [6][7][8][9][10] ; however, there was no significant difference in standard EVAR (5 studies). 6,17,[19][20][21] In addition, Stangenberg et al 21 was the only study reporting a significant fluoroscopy time reduction during standard EVAR, whereas the other 4 studies reported no difference or even an increase in fluoroscopy time as can be deduced from Table 2. Figure 3A shows the pooled results for the fluoroscopy time in standard EVAR procedures, which was not different after image fusion compared to no image fusion (0 minutes, 95% CI −3.7 to 3.6, p=0.98).…”

Section: Fluoroscopy Timementioning

confidence: 96%

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Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

et al. 2020

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Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR). Materials and Methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors’ center. Mean differences (MDs) are presented with the 95% confidence interval (CI). Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of −29 mL (95% CI −40.5 to −18.5, p<0.001) and −11 minutes (95% CI −21.0 to −1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD −79 mL, 95% CI −105.7 to −52.4, p<0.001), fluoroscopy time (MD −14 minutes, 95% CI −24.2 to −3.5, p<0.001), and procedure time (MD −52 minutes, 95% CI −75.7 to −27.9, p<0.001). Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR.

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Section: Contrast Volumesupporting

confidence: 69%

Section: Fluoroscopy Timementioning

confidence: 96%

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

et al. 2020

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“…In most FI studies, a CBCT was acquired in order to register in 3D-3D fashion. There is limited published data on 2D-3D FI registration for guidance of standard EVAR with feasibility rates of up to 95.5% [9,11,[17][18][19]. In this study, the feasibility rate for registration was 100%.…”

Section: Discussionmentioning

confidence: 75%

Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

Barkhausen¹,

Wiedner²,

Stahlberg³

et al. 2019

RDI

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Background: Standard endovascular aortic repair (EVAR) is frequently performed with few data regarding utilization of 2D-3D fusion imaging (FI). Purpose: To evaluate a) feasibility and safety of 2D-3D FI to guide limb deployment during EVAR and b) efficacy of this technique compared to standard use of digital subtraction angiography (DSA) for guidance. Materials and Methods: Iliac limb deployment by guidance of 2D-3D FI (FUSION group, n=22 limbs) during EVAR was compared to (STANDARD group, n=23 limbs). Retrospectively, we analyzed feasibility (success-rate) and safety (patency of hypogastric artery; type Ib/III endoleak) of FI for limb deployment (FUSION group). Total contrast (ml) and median dose area product (mGy*cm2) per group to visualize the iliac bifurcation were compared. Results: In the FUSION group, limb deployment was performed in 19/22 limbs (86.4%) and all hypogastric arteries were patent at the end of the procedure. Median volumes of contrast per bifurcation were 13.0 ml (RANGE 13–13ml) in the STANDARD and 2.2ml (RANGE 0–13ml) in the FUSION group (p=0.002); median dose area products per bifurcation were 11951mGy*cm2 and 2593.1mGy*cm2 (p=0.001), respectively. Conclusion: Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions. Therefore, FI should be used whenever possible

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“…For each patient, fusion imaging was employed using the EndoNaut® (Therenva, France) station for navigation and positioning of the stent graft (12). Four surgeons participated in the study (2 junior surgeons with less than 5 years of experience and 2 senior surgeons with more than 10 years of experience).…”

Section: Fusion Imaging Workflowmentioning

confidence: 99%

“…In both cases, published studies, reviewed in the recent meta-analysis of Goudeketting et al (3), have shown that such augmented reality systems are capable of reducing the X-ray exposure time and the quantity of contrast agent injected. Specifically, use of 3D image fusion in standard and complex EVAR is associated with a significant decrease in contrast use, while radiation doses, procedure times, and fluoroscopy times are reduced in most studies, although not always significantly (4,11,12).…”

Section: Introductionmentioning

confidence: 99%

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

Lalys¹,

Barré²,

Kafi³

et al. 2019

Journal of Vascular and Interventional Radiology

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Purpose. To quantify the displacement of the vascular structures after insertion of stiff devices during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm, and to identify potential parameters influencing this displacement. Materials and Methods. A total of 50 patients from a single center undergoing EVAR were prospectively enrolled between January 2016 and December 2017. Fusion imaging was employed using the EndoNaut® (Therenva, France) station through a 3D/2D technology synchronizing the 3D CT-scan to the live intraoperative fluoroscopy. The accuracy of the fusion road-map was evaluated before deployment by conventional digital subtraction angiogram on a single plane (with different Carm incidences). Results. The mean displacement error of the ostium of the lowest renal artery was 4.1 +/-2.4 mm (range 0-11.7 mm), with a left/right displacement of 1.6 +/-1.7 mm (range 0-6.9 mm) and a craniocaudal displacement of 3.5 +/-2.4 mm (range 0-11.3 mm). The correction required for the ostium of the lower renal artery was mostly cranial and to the left. Multiple linear regression analysis revealed only the sharpest angle between the aneurysm neck and sac as the factor influencing the accuracy of fusion imaging. All other parameters didn't show any correlation. 1 A c c e p t e d M a n u s c r i p t Conclusion. This study identified the sources of fusion error after insertion of rigid material during EVAR. As the sharpest angulation between aneurysm neck and sac increases, the overall accuracy of the fusion might be affected.

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Fusion Imaging for EVAR with Mobile C-arm

Cited by 16 publications

References 27 publications

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

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