Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization

Abstract

C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.

New advances in lower gastrointestinal bleeding management with embolotherapy

“…Even transient movement during image acquisition negatively affects the quality of the entire image, resulting in risk of misinterpretation. 9,10 However, in our experience, the combination with the AVD software helps in the interpretation of the CBCT data set and provides the correct path to the bleeder also in the case of mild motion artefacts (Figure 3a-d).…”

“…The feasibility and utility of CBCT and vessel-tracking software has primarily been proven in targeted chemoembolization of liver malignancies and benign prostate hyperplasia, with a reported detection accuracy of around 90% in detecting feeding branches. [8][9][10] Iwazawa and Carrafiello reported first experiences in emergency transarterial embolization. 9,10 On the basis of the data reported above, the use of angiographic CBCT and AVD software during embolization of arterial bleedings can improve operator confidence with embolization techniques in emergency settings, reduce overall procedural time and total contrast media administration and ultimately have an impact on treatment outcome.…”

“…12 Coagulopathy is a negative-predictive factor for survival, bleeding control and rebleeding in patients with LGIB. 9,10 Onyx has the remarkable advantage of acting independently of any underlying coagulopathy or low platelet count. 9,10 On the basis of the characteristics described above, Onyx could present some advantages in the embolotherapy of LGIB.…”

“…8,9 Further, the software visualizes the arterial path from the catheter tip to the target site on a 3D vascular map at the optimal working angle, enabling easier, quicker and more accurate target catheterization (Figure 2a,b).…”

“…If the bleeding site was not correctly depicted on DP-CBCT images, CTA data sets could be imported into the 3D workstation and CBCT-CT fusion can be performed: target segmentation may be performed on the CTA data set. Once the target culprit artery is reached, a selective angiogram is performed to confirm correct position 9 ( Figure 1a-d).…”