Impact of Cone Beam Computed Tomography in Advanced Endovascular Aortic Aneurysm Repair Using Last Generation 3D C-arm

Mezzetto, Luca; Mastrorilli, Davide; Abatucci, Giacomo; Scorsone, Lorenzo; Macrì, Marco; Criscenti, Paolo; Gennai, Stefano; Veraldi, Edoardo; Veraldi, Gian Franco

doi:10.1016/j.avsg.2021.04.035

Cited by 8 publications

(10 citation statements)

References 25 publications

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“…Although similar stent graft assessment can be made by CBCT, CT imaging has superior contrast resolution compared to CBCT, in addition to advantages with respect to field of view and scan length as well as to the possibility of applying artefact reduction algorithms. Opposed to studies utilizing CBCT (5,7,12), we did not demonstrate CT findings requiring prompt corrective interventions. In one study, CBCT demonstrated stent graft kinks or compressions in 22% of f-bEVAR patients, and approximately 10% underwent immediate revision (7).…”

Section: Discussioncontrasting

confidence: 73%

“…The accurate placement of all endograft components is crucial for a durable result. In fenestrated and branched endovascular aortic repair (f-bEVAR), satisfactory assessment of all endograft components can be difficult with two-dimensional angiography and fluoroscopy alone ( 3 – 9 ). Unwanted findings such as stent compression or kinking, insufficient bridging or flaring of branch stents are easily detected on conventional CT or cone beam computed tomography (CBCT) imaging ( 4 , 7 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

et al. 2023

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Background Endovascular aortic repair with fenestrated or branched endografts is technically challenging, and proper intraoperative assessment of all stent graft components with only angiography and fluoroscopy can be difficult. Intraoperative computed tomography (CT) imaging can be a valuable aid for the operators in the evaluation of stent grafting results prior to completion of surgery. Purpose To examine the feasibility of performing intraoperative CT imaging during fenestrated and branched endovascular aortic repair (f-bEVAR) under sterile conditions and with patients under general anesthesia. Material and Methods Intraoperative CT imaging was performed in 10 patients undergoing elective aortic repair with fenestrated or branched endografts. Adverse events, time consumption for CT set-up and image acquisition, and additional radiation dose to the patient were recorded. CT image quality was graded. Immediate corrective maneuvers performed based on the CT findings was registered. Results There were no adverse events related to intraoperative CT imaging. The median additional operating time by including intraoperative CT was 16 min (interquartile range [IQR] = 12–19), comprising 7% of the median total operating time. The median estimated additional radiation dose to the patient was 4.8 mSv (IQR = 3.8–4.9). All intraoperative CT examinations were considered to be of sufficient quality for stent graft evaluation. No immediate corrective procedures were performed on the basis of CT findings in this study cohort. Conclusion CT imaging intraoperatively during f-bEVAR is feasible with an acceptable increase in operating time and radiation dose.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

et al. 2023

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“…The adjunctive value of intra-procedural, 3D cross-sectional imaging has been demonstrated in various interventional procedures. 13–15 The benefit of intra-procedural 3D rotational angiography in the setting of visceral aneurysms has been reported earlier, especially when information from preoperative imaging is not exhaustive. 8 Intra-arterial CBCTA has also been reported to better delineate intracranial aneurysms, fistulas, and malformations than DSA alone.…”

Section: Discussionmentioning

confidence: 92%

Added Value of Selective Intra-arterial Cone-Beam CT Angiography in the Management of Visceral Artery Aneurysms

et al. 2022

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Purpose: The aim of this study is to evaluate the value of selective intra-arterial cone-beam computed tomography angiography (CBCTA) relative to conventional computed tomography angiography (CTA) in understanding visceral artery aneurysm (VAA) morphology, and its impact on treatment planning. Materials and Methods: Between January 2017 and August 2021, all patients who had a diagnosis of VAA and underwent intraoperative CBCTA imaging were retrospectively reviewed. Impact on treatment decisions, optimal C-arm angulations derived from CBCTA, and additional radiation exposure were reported. Two blinded independent reviewers qualitatively reviewed CBCTA and conventional CTA images. A 5-point Likert scale (1=poor image quality, 5=excellent image quality) was used to assess the overall image quality of each modality. Number of vessels arising from the aneurysm sac was counted. Results: A total of 16 patients had a diagnosis of VAA during the study period, of whom 10 patients had intraoperative CBCTA and conventional CTA available for review. Out of 10 patients, 7 underwent successful endovascular treatment, 2 were deemed not amenable for endovascular embolization based on intraoperative CBCTA findings, and 1 had resolved pseudoaneurysm. Total fluoroscopy time and radiation dose (dose area product [DAP] and skin dose) for all procedures were 27.7 ± 19.9 minutes, 28 362 (±18 651) µGy*m2, and 1879 (±1734) mGy, respectively. Radiation exposure from CBCTA (DAP and skin dose) was 5703 (±3967) µGy*m2 and 223.6 (±141.3) mGy, respectively. In patients who underwent endovascular treatment, the proportional DAP from CBCTA was 18.3% (±15.3%) of the total procedural radiation dose. Qualitative rating of overall image quality of CBCTA images was superior to CTA images (mean score: 4.55 vs 3, p<0.001). More branch vessels arising from the VAA were identified by all reviewers in CBCTA as compared with conventional CTA (median, min-max: 3, 0–4 vs 2,1–3 vessels). Conclusion: Intraoperative CBCTA after selective intra-arterial contrast injection, with better spatial resolution, provided better delineation of visceral aneurysm morphology as compared with conventional, intravenous CTA and enabled optimal treatment planning at a reasonable additional radiation exposure. Clinical Impact Visceral artery aneurysms (VAA) are often diagnosed incidentally by conventional computed tomographic angiography (CTA). Endovascular treatment typically requires selective angiographies at multiple projections to better understand aneurysm morphology, location, and efferent branch vessels. Intra-arterial cone-beam CT angiography (CBCTA) for VAA has the advantage of selective contrast opacification, better spatial resolution, and three-dimensional/multi-planar visualization of aneurysm morphology. In addition, CBCTA enables identification of optimal C-arm working projection for subsequent endovascular treatment. The aim of this study is to evaluate the value of intraoperative CBCTA relative to conventional CTA in understanding visceral artery aneurysm morphology and its impact on treatment planning.

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“…under general anesthesia in an operating room equipped with a mobile digital angiographic C-arm (Ziehm Vision RFD 3D, Ziehm Imaging; Nürnberg, Germany). 9 Common femoral artery endarterectomy was the common step for all procedures while inflow and/or outflow endovascular revascularization was performed when appropriate.…”

Section: Methodsmentioning

confidence: 99%

Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia

et al. 2021

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Objective The aim of the study was to evaluate the outcome of first line hybrid treatment in patients with chronic limb threatening ischemia (CLTI) and to evaluate possible predictors of primary patency (PP) loss and limb clinical improvement (LCI). Methods This was a retrospective non-randomized study. All patients underwent one-stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularization procedure. Demographic, clinical, and lesion characteristics for each patient were reported. Primary patency analysis was performed using Kaplan–Meier life tables, and univariate and multivariate analysis was used to assess possible predictors of PP loss and clinical improvement. Results Complete data were obtained from 132 patients. Patients were divided into two groups according to their Rutherford’s category (RC), group 1 (Rutherford 4) and group 2 (Rutherford 5 and 6). Technical success was 98%. The overall surgical peri-operative complication rate was 8%. At a mean follow-up of 32 ± 23 months, the rate of major adverse limb events (MALE) was 30%; only the rate of major amputation between two groups was significant statistically different ( p = .006). Group 1 had significantly lower amputation rate at 36 months ( p = .01). The presence of high iliac peripheral artery calcium scoring system (PACCS) grade (HR 9.43, 95% CI 2.40–36.9, p = .001), the poor run-off of leg vessels (HR 0.15, 95% CI 0.02–0.92, p = .04), and undergoing CFA endarterectomy combined with outflow endovascular revascularization procedure (HR 4.25, 95% CI 1.07–16.89, p = .04) were independent predictors of PP loss, while severe iliac artery stenosis (OR 0.09, 95% CI 0.02–0.32, p = <.001) and the presence of pre-operative patent leg vessels (OR 8.03, 95% CI 2015–29.95, p = .002) were the significant independent predictors of LCI. Conclusion The use of hybrid first line approach in patients with CLTI is a safe and feasible technique. From the analysis of the current study, it is clear that any effort should be made to achieve as many patency leg vessels as possible in order to obtain better and longer lasting clinical outcomes.

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Impact of Cone Beam Computed Tomography in Advanced Endovascular Aortic Aneurysm Repair Using Last Generation 3D C-arm

Cited by 8 publications

References 25 publications

Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

Added Value of Selective Intra-arterial Cone-Beam CT Angiography in the Management of Visceral Artery Aneurysms

Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia

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