Intra-operative DynaCT improves technical success of endovascular repair of abdominal aortic aneurysms

Abstract

Most graft-related complications that mandate early reintervention following EVAR are due to remediable technical problems which are not identified by uniplanar completion angiography alone. DynaCT is a feasible intra-operative adjunct to completion angiography, which improves intra-operative quality control during endovascular repair of abdominal aortic aneurysms.

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

“…7 The results of the study by Biasi et al showed that early complications were due to technical failures in up to 86% of cases and supposedly corrected with better intra-operative imaging. 7 The use of CBCT resulted in adjunctive procedures in 6.25% of the patients in the study by Biasi et al,7 while in the present study 8.1% of the patients had benefited from the CBCT intra-operatively. Abbruzzese et al reported adjunctive procedures in 25% of patients of whom approximately 14% were technical failures and the other procedures were to treat endoleaks.…”

“…This issue has been described earlier and has been a major limitation of the technique. 7,8 A software upgrade during the trial enabled a vertical (portrait) mode, which is superior in studying the stent graft. The detector is simply rotated 90 degrees thus allowing capture of a greater cranio-caudal segment (30 Â 40 cm).…”

The Hybrid Operating Room

“…CT-like imaging with the angiographic C-arm enables the surgeon to diagnose this complication intraoperatively and correct it. A group from University of London (Biasi et al, 2009) demonstrated in a study of 80 patients undergoing EVAR that 3D imaging with DynaCT in the operating room was able to detect endoleaks in 5 patients. These endoleaks were not detected by conventional completion angiography.…”

Transcatheter aortic valve replacement: where will we be in 5 years?

“…Intraoperative real-time three-dimensional transoesophageal echocardiography and dynamic computed tomography (Dyna-CT) [7,8] are other examples of ongoing development. Modern angiography systems offer advanced imaging, postprocessing image fusion capabilities with previously acquired three-dimensional volumes (e.g., CT, MRI, PET, single photon emission computed tomography images), and real-time threedimensional intraoperative navigation.…”