Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair

Tenorio, Emanuel R.; Oderich, Gustavo S.; Sandri, Giuliano A.; Ozbek, Pinar; Kärkkäinen, Jussi M.; Macedo, Thanila A.; Vrtiska, Terri J.; Cha, Stephen

doi:10.1016/j.jvs.2018.07.040

Cited by 52 publications

(37 citation statements)

References 40 publications

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“…They observed an increased technical success rate when F-BEVAR was performed in a modern HOR with fusion imaging and CBCT (99.4% vs 98.8%, p<0.05), which was associated with lower rates of 30-day mortality (1% vs 4%, p<0.05) and early reinterventions (4% vs 10%, p<0.05). 16 Our study reported a significant decrease in contrast medium volume and radiation exposure for procedures performed in hybrid rooms, which is consistent with the literature. 6,8,17,18 Our technical success increase was however not statistically significant, possibly due to a higher case complexity in the HOR group with higher total number of target vessels and average number of fenestrations and/or branches per graft (p<0.01).…”

Section: Discussionsupporting

confidence: 92%

“…1,3,9,15 Routine use of fusion imaging and CBCT should theoretically help increase short- and long-term technical success rates of all endovascular procedures, especially F-BEVAR. Tenorio et al 16 reported in 2019 a review of 386 patients treated with F-BEVAR between 2007 and 2017 on different imaging systems. They observed an increased technical success rate when F-BEVAR was performed in a modern HOR with fusion imaging and CBCT (99.4% vs 98.8%, p<0.05), which was associated with lower rates of 30-day mortality (1% vs 4%, p<0.05) and early reinterventions (4% vs 10%, p<0.05).…”

Section: Discussionmentioning

confidence: 99%

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Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

et al. 2021

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Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

et al. 2021

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“…20 Our group uses postimplant cone beam CT intraoperatively to allow immediate assessment and revision of technical problems for IBDs and other complex endovascular aortic procedures. 21 Two events of new-onset buttock claudication related to buttock ischemia were recorded in the current series, one for each group. One patient suffered perioperative buttock claudication as a result of technical failure to deploy the bridging stent-graft within the posterior division branch, while the other occurred as a result of symptomatic IIA side branch occlusion that was left untreated.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

et al. 2020

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Purpose: To evaluate the outcomes of the Gore Excluder Iliac Branch Endoprosthesis (IBE) using division branches of the internal iliac artery (IIA) as distal landing zones. Materials and Methods: Between January 1, 2014, and December 31, 2018, 74 patients (mean age 74±7 years; 72 men) treated for aortoiliac or common iliac artery aneurysms had an IBE deployed with distal landing of the side branch within the main trunk (n=60) of the internal iliac artery (IIA) vs within a division branch (n=25). Thirteen (17%) patients received bilateral IBE implantations for a total of 85 vessels evaluated. Early endpoints were technical success, 30-day mortality, 30-day major adverse events (MAEs), and 30-day major access complications. Late endpoints were survival, primary and secondary IIA patency, freedom from IIA branch instability, freedom from new-onset buttock claudication, and aneurysm sac diameter changes. Time-dependent outcomes were reported as Kaplan-Meier curves with differences assessed using the log-rank test. Estimates are presented with the 95% confidence interval (CI). Results: The overall technical success rate was 97%, with 1 technical failure per group (p=0.43). Two patients, one from each group, died within 30 days (p=0.43). No significant differences were seen in the rates of 30-day MAEs (7% vs 17%, p=0.35) or major access complications (9% vs 11%, p>0.99) for patients receiving distal landing in the main trunk vs a division branch, respectively. The mean follow-up for the entire cohort was 19±12 months. The overall 1-year survival rate was 94% (95% CI 74% to 99%). The primary and secondary patency rates at 1 year were 98% (95% CI 88% to 99%) vs 95% (95% CI 72% to 99%, p=0.72) and 98% (95% CI 88% to 99%) vs 100% (p=0.41) for the main trunk vs division branch groups, respectively. Freedom from IIA branch instability estimates were also similar at 1-year follow-up [93% (95% CI 82% to 97%) vs 90% (95% CI 66% to 97%), p=0.29], as were the freedom from new-onset buttock claudication estimates [98% (95% CI 86% to 99%) and 94% (95% CI 67% to 99%), respectively; p=0.62]. Mean sac diameter change was 5.4±5.3 mm, not significantly different between the groups (p=0.85). Conclusion: Use of the posterior or anterior division of the IIA as a distal landing zone for the Gore Excluder IBE was safe and efficacious in the midterm. This technique may permit extending indications for endovascular repair of aortoiliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Long-term assessment is needed to affirm the efficacy of this technique.

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“…14 While the utilization of IVUS, three-dimensional fusion imaging, and cone-beam computed tomography in the operating suite have reduced reliance on fluoroscopy, it still remains a vital tool during endovascular procedures. 15,16 Treatment of CVI attributed to chronic venous outflow obstruction has historically been treated with venovenous bypass or other open surgical reconstruction; however, iliac vein stenting has been established as an endovascular alternative with proven safety and efficacy. 1,2 The radiation exposure associated with iliofemoral endovenous procedures is relatively unknown; however, a recent study by Barbati et al documented a single-center experience with recanalization of chronic occlusive lesions.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiation exposure during non-thrombotic iliac vein stenting

et al. 2019

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Objective Fluoroscopic-guided interventions have become a major part of the modern vascular surgeon’s practice. Imaging is typically required to safely and effectively perform both simple and complex endovascular interventions. With an ever-increasing volume of fluoroscopic-guided interventions being performed each year, the minimization of harmful radiation exposure has become of paramount concern for both patients and providers. The purpose of this study was to identify the extent of radiation exposure associated with venography and iliac vein stenting, an intervention utilized in the management of chronic venous insufficiency. Methods This was a single-center, retrospective analysis of 40 venograms performed on 29 unique patients over a three-month period. Patients with signs and symptoms of chronic venous insufficiency who failed conservative therapy underwent evaluation of the vena cava and iliofemoral veins with venography and intravascular ultrasound. Stent placement was performed if a >50% cross-sectional area or diameter reduction was identified via intravascular ultrasound. All patients were found to have non-thrombotic iliac vein lesions. All patients wore two individual film badge dosimeters – one on their chest and the other on the abdomen. The same mobile C-arm system was used for all interventions. Results There were 15 males and 14 females, with an average age of 70.6 years old (SD ± 9.5; range 53–89) and a mean body mass index of 33.9 kg/m2. Sixteen limbs had C6 disease, 10 had C4 disease, and 14 had C3 disease. Thirty-eight of the 40 procedures resulted in stent placement, with an average of 1.13 stents placed per intervention. The average fluoroscopy time was 76.5 s (SD ± 36.9; range 7.8–209.5), and the mean cumulative air kerma was 1.08 mGy (SD ± 0.55; range 0.362–2.24). Average cumulative air kerma was higher in procedures resulting >1 stent placement compared to those with placement of ≤1 stent (1.44 vs. 1.02 mGy; p = 0.04). Fluoroscopy time was also higher in procedures with >1 stent placed (120.1 vs. 68.8 s; p = 0.0004). The mean deep dose equivalent per procedure from the patient-worn abdominal badge was 0.221 mSv. Conclusion With the adjunctive use of intravascular ultrasound, iliac vein stenting can be safely and effectively performed with very low utilization of fluoroscopy, and therefore radiation exposure can be minimized for both patients and surgeons. Placement of >1 iliac vein stent resulted in higher cumulative air kerma and fluoroscopy time.

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Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair

Cited by 52 publications

References 40 publications

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

Radiation exposure during non-thrombotic iliac vein stenting

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