Intra-operative Cone Beam Computed Tomography can Help Avoid Reinterventions and Reduce CT Follow up after Infrarenal EVAR

Törnqvist, Per; Dias, Nuno; Sonesson, Björn; Kristmundsson, Thórarinn; Resch, Timothy

doi:10.1016/j.ejvs.2015.01.009

Cited by 48 publications

(45 citation statements)

References 18 publications

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“…Our report also illustrates the utility of performing immediate assessment with CBCT, which was not done at the time of the initial implant. Intraoperative assessment with CBCT ensures immediate identification of stent kink, compression or infolding, and endoleaks and may decrease the rate of avoidable reinterventions as illustrated by this case 11, 12…”

Section: Discussionmentioning

confidence: 96%

Severe infolding of fenestrated-branched endovascular stent graft

Mirza

Sandri

Tenorio

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Infolding of a fenestrated-branched stent graft is an infrequent complication due to excessive oversizing. We report the case of an 89-year-old man who underwent a four-vessel fenestrated-branched endovascular aortic repair for a pararenal aortic aneurysm. Computed tomography angiography revealed severe infolding across the mesenteric-renal vessels. The patient was treated by angioplasty and placement of Palmaz stent. Cone-beam computed tomography confirmed patent visceral vessels with resolution of the infolding. This case illustrates an uncommon complication that can be prevented by modifications in the stent design and by immediate assessment using intraoperative cone-beam computed tomography.

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Section: Discussionmentioning

confidence: 96%

Severe infolding of fenestrated-branched endovascular stent graft

Mirza

Sandri

Tenorio

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…This resulted in a significant reduction in both radiation exposure and contrast volume [74]. Another group found that cone beam CT was better able to identify stent-graft compressions and kinks than digital subtraction contrast angiography, but did miss (type II) endoleaks that were detected on digital subtraction angiography (of note, none of the "missed" endoleaks required further intervention) [75]. This combination of completion imaging may obviate the need for early follow-up CTA.…”

Section: Follow-up Imagingmentioning

confidence: 92%

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

O’Mara

Bersin

2016

Curr Treat Options Cardio Med

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Endovascular aneurysm repair (EVAR) has become the predominant method of treatment for abdominal aortic aneurysms (AAA). The use of conscious sedation with local anesthesia and percutaneous femoral access has further decreased the morbidity of the procedure. Current devices can more effectively manage increasingly "hostile" aneurysm necks, while chimney grafts or dedicated fenestrated stent-grafts can be used for juxta-renal disease with favorable results. However, endovascular repair does present a new set of challenges, and endoleaks remain an area of concern. While there is general consensus that type I and type III endoleaks require treatment, type II endoleaks are the topic of ongoing research and debate. Development of devices and techniques to prevent and treat endoleak continues to progress. Advances in contrast-enhanced ultrasound are reducing reliance on computed tomography for post-operative monitoring. This is an important step in this population at high risk for the development of kidney failure. Despite these many innovations, further research is needed to optimize the care of patients with AAA.

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“…With the progressive development of hybrid operating rooms in vascular surgery, cone-beam CT (CBCT) mounted on a C-arm becomes an increasingly commonly used imaging technology in vascular interventions, such as endovascular aneurysm repair (EVAR), thanks to its capability of 3D imaging of arterial structures and less radiation in comparison with multi-slice CT [1–5]. There are at least two advantages of 3D CBCT acquisition during EVAR.…”

Section: Introductionmentioning

confidence: 99%

An improved nonlinear diffusion in Laplacian pyramid domain for cone beam CT denoising during image-guided vascular intervention

et al. 2018

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BackgroundCone-beam computed tomography (CBCT) acquisition during endovascular aneurysm repair is an emergent technology with more and more applications. It may provide 3-D information to achieve guidance of intervention. However, there is growing concern on the overall radiation doses delivered to patients, thus a low dose protocol is called when scanning. But CBCT images with a low dose protocol are degraded, resulting in streak artifacts and decreased contrast-to-noise ratio (CNR). In this paper, a Laplacian pyramid-based nonlinear diffusion is proposed to improve the quality of CBCT images.MethodWe first transform the CBCT image into its pyramid domain, then a modified nonlinear diffusion is performed in each level to remove noise across edges while keeping edges as far as possible. The improved diffusion coefficient is a function of the gradient magnitude image; the threshold in the modified diffusion function is estimated using the median absolute deviation (MAD) estimator; the time step is automatically determined by iterative image changes and the iteration is stopped according to mean absolute error between two adjacent diffusions. Finally, we reconstruct the Laplacian pyramid using the processed pyramid images in each level.ResultResults from simulation show that the filtered image from the proposed method has the highest peak signal-noise ratio (81.92), the highest correlation coefficient (99.77%) and the lowest mean square error (27.61), compared with the other four methods. In addition, it has highest contrast-to-noise ratio and sharpness in ROIs. Results from real CBCT images show that the proposed method shows better smoothness in homogeneous regions meanwhile keeps bony structures clear.ConclusionSimulation and patient studies show that the proposed method has a good tradeoff between noise/artifacts suppression and edge preservation.Electronic supplementary materialThe online version of this article (10.1186/s12880-018-0269-1) contains supplementary material, which is available to authorized users.

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Intra-operative Cone Beam Computed Tomography can Help Avoid Reinterventions and Reduce CT Follow up after Infrarenal EVAR

Cited by 48 publications

References 18 publications

Severe infolding of fenestrated-branched endovascular stent graft

Severe infolding of fenestrated-branched endovascular stent graft

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

An improved nonlinear diffusion in Laplacian pyramid domain for cone beam CT denoising during image-guided vascular intervention

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