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De Boer SW, Heinen SGH, Goudeketting SR, De Haan MW, Mees BM, Van Den Heuvel DAF, De Vries JPPM. Novel diagnostic and imaging techniques in endovascular iliac artery procedures. Expert Rev Cardiovasc Ther 2020; 18:395-404. [PMID: 32544005 DOI: 10.1080/14779072.2020.1780916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endovascular revascularization has become the preferred treatment for most patients with iliac artery obstructions, with a high rate of clinical and technical success. AREAS COVERED This review will describe novel developments in the diagnosis and treatment of iliac artery obstructions including the augmentation of preprocedural imaging with advanced flow models, image fusion techniques, and state-of-the-art device-tracking capabilities. EXPERT OPINION The combination of these developments will change the endovascular field within the next 5 years, allowing targeted iliac treatment without the need for radiographic imaging or iodinated contrast media.
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Affiliation(s)
- Sanne W De Boer
- Department of Radiology, Maastricht University Medical Center+ , Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University , Maastricht, The Netherlands
| | - Stefan G H Heinen
- Department of Radiology, St. Antonius Hospital , Nieuwegein, The Netherlands
| | | | - Michiel W De Haan
- Department of Radiology, Maastricht University Medical Center+ , Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University , Maastricht, The Netherlands
| | - Barend M Mees
- CARIM School for Cardiovascular Diseases, Maastricht University , Maastricht, The Netherlands.,Department of Vascular Surgery, Maastricht University Medical Center+ , Maastricht, The Netherlands
| | | | - Jean-Paul P M De Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen , Groningen, The Netherlands
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Jansen M, Khandige A, Kobeiter H, Vonken EJ, Hazenberg C, van Herwaarden J. Three Dimensional Visualisation of Endovascular Guidewires and Catheters Based on Laser Light instead of Fluoroscopy with Fiber Optic RealShape Technology: Preclinical Results. Eur J Vasc Endovasc Surg 2020; 60:135-143. [PMID: 32312666 DOI: 10.1016/j.ejvs.2020.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/09/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Fiber Optic RealShape (FORS) is a new technology platform that enables real time three dimensional (3D) visualisation of endovascular guidewires and catheters, based on the concepts of fibre optic technology instead of fluoroscopy. Anatomical context is provided by means of co-registered prior anatomical imaging, such as digital subtraction angiography or computed tomography. This preclinical study assesses the safety and feasibility of FORS technology. METHODS Six physicians performed endovascular tasks in a phantom model and a porcine model using FORS enabled floppy guidewires, Cobra-2 catheters and Berenstein catheters. Each physician performed a set of predefined tasks in both models, including setup of the FORS system, device registration, and 12 aortic and peripheral target vessel cannulation tasks. The evaluation of the FORS system was based on (i) target vessel cannulation success; (ii) safety assessment; (iii) the accuracy of the FORS based device visualisation; and (iv) user experience. RESULTS Successful cannulation was achieved in 72 of the 72 tasks (100%) in the phantom model and in 70 of the 72 tasks (97%) in the porcine model. No safety issues were reported. The FORS based device visualisation had a median offset at the tip of 2.2 mm (interquartile range 1.2-3.8 mm). The users judged the FORS based device visualisation to be superior to conventional fluoroscopic imaging, while not affecting the mechanical properties (torquability, pushability) of the FORS enabled guidewire and catheters. CONCLUSION The combined outcomes of high cannulation success, positive user experience, adequate accuracy, and absence of safety issues demonstrate the safety and feasibility of the FORS system in a preclinical environment. FORS technology has great potential to improve device visualisation in endovascular interventions.
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Affiliation(s)
- Marloes Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Hicham Kobeiter
- Department of Radiology, University Hospital CHU Henri Mondor Crétei, France
| | - Evert-Jan Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Constantijn Hazenberg
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Goudeketting SR, Heinen SGH, de Haan MW, Sailer AM, van den Heuvel DAF, van Strijen MJ, de Vries JPPM. Fluoroscopy with MRA fusion image guidance in endovascular iliac artery interventions: study protocol for a randomized controlled trial (3DMR-Iliac-roadmapping study). Trials 2018; 19:603. [PMID: 30382900 PMCID: PMC6211411 DOI: 10.1186/s13063-018-2981-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 10/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Endovascular iliac artery interventions rely on the use of two-dimensional digital subtraction angiographies with an iodinated contrast agent and ionizing radiation. The amount of iodinated contrast agent should be limited because of its potentially nephrotoxic effects. Three-dimensional (3D) image fusion requires registration of a preprocedural magnetic resonance angiogram (MRA) or computed tomography (CT) angiogram to a perprocedurally acquired cone-beam CT or two fluoroscopic orthogonal projections. After registration, the 3D angiography images can be overlaid on the fluoroscopy screen and will follow table and C-arm movements. This study will assess the added value of the 3D image fusion technique in iliac artery interventions regarding the amount of the iodinated contrast agent administered. METHODS/DESIGN The study cohort will comprise 106 patients (> 18 years) with symptomatic common and/or external iliac artery stenoses or occlusions and a recent (< 6 months) diagnostic MRA from the pelvis through the lower extremities, for which an endovascular intervention is indicated. Patients will be randomized into the control or study group (i.e. treatment without or with 3D image fusion guidance). The primary endpoint is the amount of administered iodinated contrast agent (mL). Secondary outcomes are technical success of the procedure, defined as < 30% residual stenosis over the treated lesion, fluoroscopy time, and radiation dose as dose area product (mGycm2). Patient participation in the study will be completed after hospital discharge. DISCUSSION This study is a randomized controlled multicenter trial to provide evidence on the effect of the 3D image fusion technique on the amount of administered iodinated contrast during endovascular common and/or external iliac artery interventions. TRIAL REGISTRATION Nederlands Trial Register, NTR5008 . Registered on 16 December 2014.
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Affiliation(s)
- Seline R. Goudeketting
- Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Stefan G. H. Heinen
- Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anna M. Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | | | | | - Jean-Paul P. M. de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Jones DW, Stangenberg L, Swerdlow NJ, Alef M, Lo R, Shuja F, Schermerhorn ML. Image Fusion and 3-Dimensional Roadmapping in Endovascular Surgery. Ann Vasc Surg 2018; 52:302-311. [DOI: 10.1016/j.avsg.2018.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
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Iida Y, Yoshitake A, Shimizu H. Successful Thoracic Endovascular Aortic Repair using 2- and 3-Dimensional Fusion Imaging without Further Contrast Enhancement. Ann Vasc Surg 2018; 49:314.e11-314.e13. [PMID: 29481921 DOI: 10.1016/j.avsg.2017.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
We report a case of successful thoracic endovascular aortic repair using a 3-dimensional computed tomography (3D CT) roadmap for a patient with severe contrast media allergy. As 3D CT image data were previously obtained, we integrated the data with the fluoroscopic image three dimensionally and constructed a 3D CT roadmap. This method is anticipated to be effective in patients who require less contrast enhancement or radiological dose by examining the appropriate imaging protocol for the kinds, shapes, and positions of the benchmarks for fusion.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
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Goudeketting SR, Heinen SGH, Ünlü Ç, van den Heuvel DAF, de Vries JPPM, van Strijen MJ, Sailer AM. Pros and Cons of 3D Image Fusion in Endovascular Aortic Repair: A Systematic Review and Meta-analysis. J Endovasc Ther 2017; 24:595-603. [DOI: 10.1177/1526602817708196] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - Stefan G. H. Heinen
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Hospital, Alkmaar, the Netherlands
| | | | | | - Marco J. van Strijen
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Anna M. Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
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Schwein A, Chinnadurai P, Shah DJ, Lumsden AB, Bechara CF, Bismuth J. Feasibility of three-dimensional magnetic resonance angiography-fluoroscopy image fusion technique in guiding complex endovascular aortic procedures in patients with renal insufficiency. J Vasc Surg 2016; 65:1440-1452. [PMID: 28017584 DOI: 10.1016/j.jvs.2016.10.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Three-dimensional image fusion of preoperative computed tomography (CT) angiography with fluoroscopy using intraoperative noncontrast cone-beam CT (CBCT) has been shown to improve endovascular procedures by reducing procedure length, radiation dose, and contrast media volume. However, patients with a contraindication to CT angiography (renal insufficiency, iodinated contrast allergy) may not benefit from this image fusion technique. The primary objective of this study was to evaluate the feasibility of magnetic resonance angiography (MRA) and fluoroscopy image fusion using noncontrast CBCT as a guidance tool during complex endovascular aortic procedures, especially in patients with renal insufficiency. METHODS All endovascular aortic procedures done under MRA image fusion guidance at a single-center were retrospectively reviewed. The patients had moderate to severe renal insufficiency and underwent diagnostic contrast-enhanced magnetic resonance imaging after gadolinium or ferumoxytol injection. Relevant vascular landmarks electronically marked in MRA images were overlaid on real-time two-dimensional fluoroscopy for image guidance, after image fusion with noncontrast intraoperative CBCT. Technical success, time for image registration, procedure time, fluoroscopy time, number of digital subtraction angiography (DSA) acquisitions before stent deployment or vessel catheterization, and renal function before and after the procedure were recorded. The image fusion accuracy was qualitatively evaluated on a binary scale by three physicians after review of image data showing virtual landmarks from MRA on fluoroscopy. RESULTS Between November 2012 and March 2016, 10 patients underwent endovascular procedures for aortoiliac aneurysmal disease or aortic dissection using MRA image fusion guidance. All procedures were technically successful. A paired t-test analysis showed no difference between preimaging and postoperative renal function (P = .6). The mean time required for MRA-CBCT image fusion was 4:09 ± 01:31 min:sec. Total fluoroscopy time was 20.1 ± 6.9 minutes. Five of 10 patients (50%) underwent stent graft deployment without any predeployment DSA acquisition. Three of six vessels (50%) were cannulated under image fusion guidance without any precannulation DSA runs, and the remaining vessels were cannulated after one planning DSA acquisition. Qualitative evaluation showed 14 of 22 virtual landmarks (63.6%) from MRA overlaid on fluoroscopy were completely accurate, without the need for adjustment. Five of eight incorrect virtual landmarks (iliac and visceral arteries) resulted from vessel deformation caused by endovascular devices. CONCLUSIONS Ferumoxytol or gadolinium-enhanced MRA imaging and image fusion with fluoroscopy using noncontrast CBCT is feasible and allows patients with renal insufficiency to benefit from optimal guidance during complex endovascular aortic procedures, while preserving their residual renal function.
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Affiliation(s)
- Adeline Schwein
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Ponraj Chinnadurai
- Advanced Therapies, Siemens Medical Solutions USA Inc, Hoffman Estates, Ill
| | - Dipan J Shah
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Alan B Lumsden
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Carlos F Bechara
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Jean Bismuth
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
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Schwein A, Lu T, Chinnadurai P, Kitkungvan D, Shah DJ, Chakfe N, Lumsden AB, Bismuth J. Magnetic resonance venography and three-dimensional image fusion guidance provide a novel paradigm for endovascular recanalization of chronic central venous occlusion. J Vasc Surg Venous Lymphat Disord 2016; 5:60-69. [PMID: 27987612 DOI: 10.1016/j.jvsv.2016.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Endovascular recanalization is considered first-line therapy for chronic central venous occlusion (CVO). Unlike arteries, in which landmarks such as wall calcifications provide indirect guidance for endovascular navigation, sclerotic veins without known vascular branching patterns impose significant challenges. Therefore, safe wire access through such chronic lesions mostly relies on intuition and experience. Studies have shown that magnetic resonance venography (MRV) can be performed safely in these patients, and the boundaries of occluded veins may be visualized on specific MRV sequences. Intraoperative image fusion techniques have become more common to guide complex arterial endovascular procedures. The aim of this study was to assess the feasibility and utility of MRV and intraoperative cone-beam computed tomography (CBCT) image fusion technique during endovascular CVO recanalization. METHODS During the study period, patients with symptomatic CVO and failed standard endovascular recanalization underwent further recanalization attempts with use of intraoperative MRV image fusion guidance. After preoperative MRV and intraoperative CBCT image coregistration, a virtual centerline path of the occluded segment was electronically marked in MRV and overlaid on real-time two-dimensional fluoroscopy images. Technical success, fluoroscopy times, radiation doses, number of venograms before recanalization, and accuracy of the virtual centerline overlay were evaluated. RESULTS Four patients underwent endovascular CVO recanalization with use of intraoperative MRV image fusion guidance. Mean (± standard deviation) time for image fusion was 6:36 ± 00:51 mm:ss. The lesion was successfully crossed in all patients without complications. Mean fluoroscopy time for lesion crossing was 12.5 ± 3.4 minutes. Mean total fluoroscopy time was 28.8 ± 6.5 minutes. Mean total radiation dose was 15,185 ± 7747 μGy/m2, and mean radiation dose from CBCT acquisition was 2788 ± 458 μGy/m2 (18% of mean total radiation dose). Mean number of venograms before recanalization was 1.6 ± 0.9, whereas two lesions were crossed without any prior venography. On qualitative analysis, virtual centerlines from MRV were aligned with actual guidewire trajectory on fluoroscopy in all four cases. CONCLUSIONS MRV image fusion is feasible and may improve success, safety, and the surgeon's confidence during CVO recanalization. Similar to arterial interventions, three-dimensional MRV imaging and image fusion techniques could foster innovative solutions for such complex venous interventions and have the potential to affect a great number of patients.
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Affiliation(s)
- Adeline Schwein
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Tony Lu
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | | | - Danai Kitkungvan
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Dipan J Shah
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Alan B Lumsden
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Jean Bismuth
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
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Spira D, Kirchner S, Blumenstock G, Herz K, Ketelsen D, Wiskirchen J, Wiesinger B. Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector. Acta Radiol 2016; 57:587-94. [PMID: 26231951 DOI: 10.1177/0284185115597262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiation exposure remains an unceasing concern in angiographic procedures. Modern angiography machines such as analog image intensifiers (AII) or the new flat panel detectors (FPD) aim at a further dose reduction. PURPOSE To present dose area products (DAP) in a broad spectrum of therapeutic angiographic procedures, comparing an AII to an FPD angiography system. MATERIAL AND METHODS A total of 999 peripheral therapeutic angiography procedures performed with an FPD (n = 562) and an AII system (n = 437) were evaluated. DAP, fluoroscopy time, and patients' body mass index (BMI) were recorded. Interventions were classified into five main groups: percutaneous transluminal angioplasty (PTA); PTA and stent placement; intra-arterial thrombolysis; embolization procedures; and specialized interventions. RESULTS DAP values in therapeutic angiographic procedures were significantly higher when performed with the FPD compared to the AII system. The increase of the FPD versus AII system was 100.1% for PTA, 39.9% for PTA and stent placement, 187% for intra-arterial thrombolysis, 31.3% for embolization procedures, and 361% for specialized interventions. These differences persisted after standardizing DAP values to the geometric mean fluoroscopy duration of each procedure. Fluoroscopy times were shorter in all interventions performed at the FPD as compared to the AII system. DAPs increased with higher BMI, but the DAP increase of both systems with elevated BMI was variable, depending on the individual intervention. CONCLUSION In therapeutic angiographic procedures, the FPD system required higher DAPs despite shorter fluoroscopy times as compared to an AII system. Better ergonomics and speediness of the FPD system may be advantageous in the emergency setting.
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Affiliation(s)
- Daniel Spira
- Department of Diagnostic and Interventional Radiology, Universitätsklinik Heidelberg, Heidelberg, Germany
| | - Sebastian Kirchner
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University, Tübingen, Germany
| | - Klaus Herz
- Institute for Radiation Protection and Radionuclide Laboratory, Eberhard-Karls-University, Tübingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - Jakub Wiskirchen
- Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany
| | - Benjamin Wiesinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
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Tacher V, Desgranges P, You K, Ridouani F, Marzelle J, Kobeiter H. Feasibility of Three-Dimensional MR Angiography Image Fusion Guidance for Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Interv Radiol 2016; 27:188-93. [DOI: 10.1016/j.jvir.2015.08.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022] Open
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Image fusion performed with noncontrast computed tomography scans during endovascular aneurysm repair. J Vasc Surg Cases 2015; 1:53-56. [PMID: 31724594 PMCID: PMC6849901 DOI: 10.1016/j.jvsc.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022] Open
Abstract
We report two endovascular aneurysm repair procedures achieved under image fusion guidance accomplished with noncontrast injected preoperative computed tomography scans. Such use of this advanced imaging application reduces contrast media injection volume (respectively, 27 and 24 mL throughout the patients' hospital course). No changes in creatinine clearance occurred after the procedures. Contrast-enhanced ultrasound imaging confirmed technical success in both cases.
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Safety and Accuracy of Endovascular Aneurysm Repair Without Pre-operative and Intra-operative Contrast Agent. Eur J Vasc Endovasc Surg 2015; 49:255-61. [DOI: 10.1016/j.ejvs.2014.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
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Johnson C, Martin-Carreras T, Rabinowitz D. Pediatric Interventional Radiology and Dose-Reduction Techniques. Semin Ultrasound CT MR 2014; 35:409-14. [DOI: 10.1053/j.sult.2014.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sailer AM, de Haan MW, de Graaf R, van Zwam WH, Schurink GWH, Nelemans PJ, Wildberger JE, Das M. Fusion guidance in endovascular peripheral artery interventions: a feasibility study. Cardiovasc Intervent Radiol 2014; 38:314-21. [PMID: 25073947 DOI: 10.1007/s00270-014-0951-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was designed to evaluate the feasibility of endovascular guidance by means of live fluoroscopy fusion with magnetic resonance angiography (MRA) and computed tomography angiography (CTA). METHODS Fusion guidance was evaluated in 20 endovascular peripheral artery interventions in 17 patients. Fifteen patients had received preinterventional diagnostic MRA and two patients had undergone CTA. Time for fluoroscopy with MRA/CTA coregistration was recorded. Feasibility of fusion guidance was evaluated according to the following criteria: for every procedure the executing interventional radiologists recorded whether 3D road-mapping provided added value (yes vs. no) and whether PTA and/or stenting could be performed relying on the fusion road-map without need for diagnostic contrast-enhanced angiogram series (CEAS) (yes vs. no). Precision of the fusion road-map was evaluated by recording maximum differences between the position of the vasculature on the virtual CTA/MRA images and conventional angiography. RESULTS Average time needed for image coregistration was 5 ± 2 min. Three-dimensional road-map added value was experienced in 15 procedures in 12 patients. In half of the patients (8/17), intervention was performed relying on the fusion road-map only, without diagnostic CEAS. In two patients, MRA roadmap showed a false-positive lesion. Excluding three patients with inordinate movements, mean difference in position of vasculature on angiography and MRA/CTA road-map was 1.86 ± 0.95 mm, implying that approximately 95 % of differences were between 0 and 3.72 mm (2 ± 1.96 standard deviation). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for peripheral artery interventions is feasible. By reducing the number of CEAS, this technology may contribute to enhance procedural safety.
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Affiliation(s)
- Anna M Sailer
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands,
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