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Colacchio EC, Berton M, Squizzato F, Menegolo M, Piazza M, Grego F, Antonello M. The role of multimodal imaging in emergency vascular conditions: The journey from diagnosis to hybrid operating rooms. Semin Vasc Surg 2023; 36:355-362. [PMID: 37330247 DOI: 10.1053/j.semvascsurg.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Multimodal imaging is the incorporation of two or more imaging modalities during the same examination, and it has both diagnostic and treatment applications. The use of image fusion for intraoperative guidance in endovascular interventions is being extended increasingly to the field of vascular surgery, especially in the context of hybrid operating rooms. The aim of this work was to perform a review and narrative synthesis of the available literature in order to report on current applications of multimodal imaging in diagnosis and treatment of emergent vascular conditions. Of 311 records selected in the initial search, 10 articles were included in the present review: 4 cohort studies and 6 case reports. The authors have presented their experience in treating ruptured abdominal aortic aneurysms; aortic dissections; traumas; standard endovascular aortic aneurysm repair, with or without deterioration of renal function; and complex endovascular aortic aneurysm repair, and reported on the long-term clinical results. Although the current literature about multimodal imaging application in emergency vascular conditions is limited, this review highlights the potential of image fusion in hybrid angio-surgical suites, especially for diagnosing and performing treatment in the same operating room, avoiding patient transfer, and allowing procedures with zero or low-dose contrast mean.
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Affiliation(s)
- Elda Chiara Colacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy.
| | - Mariagiovanna Berton
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Francesco Squizzato
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Mirko Menegolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Michele Piazza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Franco Grego
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Michele Antonello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
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Bachrati PZ, La Torre G, Chowdhury MM, Healy SJ, Singh AA, Boyle JR. A State-of-the-Art Review of Intra-Operative Imaging Modalities Used to Quality Assure Endovascular Aneurysm Repair. J Clin Med 2023; 12:3167. [PMID: 37176608 PMCID: PMC10179131 DOI: 10.3390/jcm12093167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Endovascular aortic aneurysm repair (EVAR) is the preferred method for elective abdominal aortic aneurysm (AAA) repair. However, the success of this technique depends greatly on the technologies available. Intra-operative imaging is essential but can come with limitations. More complex interventions lead to longer operating times, fluoroscopy times, and greater contrast doses. A number of intra-operative imaging modalities to quality assure the success of EVAR have been developed. A systematic literature search was performed with separate searches conducted for each imaging modality in the study: computed tomography (CT), digital subtraction angiography (DSA), fusion, ultrasound, intra-operative positioning system (IOPS), and non-contrast imaging. CT was effective at detecting complications but commonly resulted in increased radiation and contrast dose. The effectiveness of DSA can be increased, and radiation exposure reduced, through the use of adjunctive technologies. We found that 2D-3D fusion was non-inferior to 3D-3D and led to reduced radiation and contrast dose. Non-contrast imaging occasionally led to higher doses of radiation. Ultrasound was particularly effective in the detection of type II endoleaks with reduced radiation and contrast use but was often operator dependent. Unfortunately, no papers made it past full text screening for IOPS. All of the imaging techniques discussed have advantages and disadvantages, and clinical context is relevant to guide imaging choice. Fusion and ultrasound in particular show promise for the future.
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Affiliation(s)
- Petra Z. Bachrati
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- School of Clinical Medicine, Cambridge University, Cambridge CB2 0SP, UK
| | - Guglielmo La Torre
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Mohammed M. Chowdhury
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Samuel J. Healy
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- School of Clinical Medicine, Cambridge University, Cambridge CB2 0SP, UK
| | - Aminder A. Singh
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Jonathan R. Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Eves J, Sudarsanam A, Shalhoub J, Amiras D. Augmented Reality in Vascular and Endovascular Surgery: Scoping Review. JMIR Serious Games 2022; 10:e34501. [PMID: 36149736 PMCID: PMC9547335 DOI: 10.2196/34501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/22/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Technological advances have transformed vascular intervention in recent decades. In particular, improvements in imaging and data processing have allowed for the development of increasingly complex endovascular and hybrid interventions. Augmented reality (AR) is a subject of growing interest in surgery, with the potential to improve clinicians’ understanding of 3D anatomy and aid in the processing of real-time information. This study hopes to elucidate the potential impact of AR technology in the rapidly evolving fields of vascular and endovascular surgery. Objective The aim of this review is to summarize the fundamental concepts of AR technologies and conduct a scoping review of the impact of AR and mixed reality in vascular and endovascular surgery. Methods A systematic search of MEDLINE, Scopus, and Embase was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies written in English from inception until January 8, 2021, were included in the search. Combinations of the following keywords were used in the systematic search string: (“augmented reality” OR “hololens” OR “image overlay” OR “daqri” OR “magic leap” OR “immersive reality” OR “extended reality” OR “mixed reality” OR “head mounted display”) AND (“vascular surgery” OR “endovascular”). Studies were selected through a blinded process between 2 investigators (JE and AS) and assessed using data quality tools. Results AR technologies have had a number of applications in vascular and endovascular surgery. Most studies (22/32, 69%) used 3D imaging of computed tomography angiogram–derived images of vascular anatomy to augment clinicians’ anatomical understanding during procedures. A wide range of AR technologies were used, with heads up fusion imaging and AR head-mounted displays being the most commonly applied clinically. AR applications included guiding open, robotic, and endovascular surgery while minimizing dissection, improving procedural times, and reducing radiation and contrast exposure. Conclusions AR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. These include reductions in patient risk and operating times as well as in contrast and radiation exposure for radiological interventions. Further technological advances are required to overcome current limitations, including processing capacity and vascular deformation by instrumentation.
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Affiliation(s)
- Joshua Eves
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Abhilash Sudarsanam
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Shalhoub
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Dimitri Amiras
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
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McLennan S, Soulez G, Mongrain R, Mohammadi H, Pfister M, Lessard S, Jabbour G, Therasse E. Impact of calcification modeling to improve image fusion accuracy for endovascular aortic aneurysm repair. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3556. [PMID: 34854247 DOI: 10.1002/cnm.3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 06/13/2023]
Abstract
Since the 1990s, endovascular aortic aneurysm repair (EVAR) has become a common alternative to open surgery for the treatment of abdominal aortic aneurysms (AAAs). To aid the deployment of stent-grafts, fluoroscopic image guidance can be enhanced using preoperative simulation and intraoperative image fusion techniques. However, the impact of calcification (Ca) presence on the guidance accuracy of such techniques is yet to be considered. In the present work, we introduce a guidance tool that accounts for patient-specific Ca presence. Numerical simulations of EVAR were developed for 12 elective AAA patients, both with (With-Ca) and without (No-Ca) Ca consideration. To assess the accuracy of the simulations, the image results were overlaid on corresponding intraoperative images and the overlay error was measured at selected anatomical landmarks. With this approach we gained insight into the impact of Ca presence on image fusion accuracy. Inclusion of Ca improved mean image fusion accuracy by 8.68 ± 4.59%. In addition, a positive correlation between the relative Ca presence and the image fusion accuracy was found (R = .753, p < .005). Our results suggest that considering Ca presence in patient-specific EVAR simulations increases the reliability of EVAR image guidance techniques that utilize numerical simulation, especially for patients with severe aortic Ca presence.
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Affiliation(s)
- Stewart McLennan
- Mechanical Engineering Department, McGill University, Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology Radiation-Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Rosaire Mongrain
- Mechanical Engineering Department, McGill University, Montréal, Quebec, Canada
| | - Hossein Mohammadi
- Mechanical Engineering Department, McGill University, Montréal, Quebec, Canada
| | | | - Simon Lessard
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Gilbert Jabbour
- Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology Radiation-Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada
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Avril S, Gee MW, Hemmler A, Rugonyi S. Patient-specific computational modeling of endovascular aneurysm repair: State of the art and future directions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3529. [PMID: 34490740 DOI: 10.1002/cnm.3529] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Endovascular aortic repair (EVAR) has become the preferred intervention option for aortic aneurysms and dissections. This is because EVAR is much less invasive than the alternative open surgery repair. While in-hospital mortality rates are smaller for EVAR than open repair (1%-2% vs. 3%-5%), the early benefits of EVAR are lost after 3 years due to larger rates of complications in the EVAR group. Clinicians follow instructions for use (IFU) when possible, but are left with personal experience on how to best proceed and what choices to make with respect to stent-graft (SG) model choice, sizing, procedural options, and their implications on long-term outcomes. Computational modeling of SG deployment in EVAR and tissue remodeling after intervention offers an alternative way of testing SG designs in silico, in a personalized way before intervention, to ultimately select the strategies leading to better outcomes. Further, computational modeling can be used in the optimal design of SGs in cases of complex geometries. In this review, we address some of the difficulties and successes associated with computational modeling of EVAR procedures. There is still work to be done in all areas of EVAR in silico modeling, including model validation, before models can be applied in the clinic, but much progress has already been made. Critical to clinical implementation are current efforts focusing on developing fast algorithms that can achieve (near) real-time solutions, as well as ways of dealing with inherent uncertainties related to patient aortic wall degradation on an individualized basis. We are optimistic that EVAR modeling in the clinic will soon become a reality to help clinicians optimize EVAR interventions and ultimately reduce EVAR-associated complications.
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Affiliation(s)
- Stéphane Avril
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, Saint-Étienne, France
| | - Michael W Gee
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - André Hemmler
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Sandra Rugonyi
- Biomedical Engineering Department, Oregon Health & Science University, Portland, Oregon, USA
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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Fusion Imaging to Guide Thoracic Endovascular Aortic Repair (TEVAR): A Randomized Comparison of Two Methods, 2D/3D Versus 3D/3D Image Fusion. Cardiovasc Intervent Radiol 2019; 42:1522-1529. [PMID: 31482337 DOI: 10.1007/s00270-019-02303-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the accuracy of two-dimensional (2D) versus three-dimensional (3D) image fusion for thoracic endovascular aortic repair (TEVAR) image guidance. MATERIALS AND METHODS Between December 2016 and March 2018, all eligible patients who underwent TEVAR were prospectively included in a single-center study. Image fusion methods (2D/3D or 3D/3D) were randomly assigned to guide each TEVAR and compared in terms of accuracy, dose area product (DAP), volume of contrast medium injected, fluoroscopy time and procedure time. RESULTS Thirty-two patients were prospectively included; 18 underwent 2D/3D and 14 underwent 3D/3D TEVAR. The 3D/3D method allowed more accurate positioning of the aortic mask on top of the fluoroscopic images (proximal landing zone error vector: 1.7 ± 3.3 mm) than was achieved by the 2D/3D method (6.1 ± 6.1 mm; p = 0.03). The 3D/3D image fusion method was associated with significantly lower DAP than the 2D/3D method (50.5 ± 30.1 Gy cm2 for 3D/3D vs. 99.5 ± 79.1 Gy cm2 for 2D/3D; p = 0.03). The volume of contrast medium injected was significantly lower for the 3D/3D method than for the 2D/3D method (50.6 ± 22.9 ml vs. 98.4 ± 47.9 ml; p = 0.002). CONCLUSION Higher image fusion accuracy and lower contrast volume and irradiation dose were observed for 3D/3D image fusion than for 2D/3D during TEVAR. LEVEL OF EVIDENCE II, Randomized trial.
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Schulz CJ, Böckler D, Krisam J, Geisbüsch P. Two-dimensional-three-dimensional registration for fusion imaging is noninferior to three-dimensional- three-dimensional registration in infrarenal endovascular aneurysm repair. J Vasc Surg 2019; 70:2005-2013. [PMID: 31147123 DOI: 10.1016/j.jvs.2019.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fusion imaging is a tool for intraoperative three-dimensional (3D) guidance in endovascular aneurysm repair (EVAR). In many aortic centers, the registration for location is based on an intraoperative 3D dataset acquired by means of cone-beam computed tomography (3D-3D registration). Another registration method is based on two two-dimensional (2D) images (lateral and posteroanterior) acquired with the use of intraoperative fluoroscopy for registration with a computed tomographic angiogram (2D-3D registration). The aim of the present study was to compare 2D-3D registration with 3D-3D registration regarding noninferiority in accuracy and to describe radiation exposure and ease of use of both modalities. METHODS From December 2014 to September 2015, 50 sequentially enrolled patients received EVAR with the use of fusion imaging using 2D-3D registration. No adjustments were made until the first angiography with inserted stent graft. The deviation of fusion imaging to the actual position of the lower renal artery compared with digital subtraction angiography was measured. A historic cohort of 101 patients treated with EVAR and fusion imaging with 3D-3D registration (3D-3D cohort) served as the control group for this study. RESULTS Craniocaudal deviation did not differ significantly (4.6 ± 4.4 mm in the 2D-3D cohort vs 3.6 ± 3.9 mm in the 3D-3D cohort; P = .17). The difference of the means was 1.05 mm with a 95% confidence interval of -2.45 to 0.34 and a P value for the noninferiority test of .0249, indicating that 2D-3D registration was noninferior in terms of a margin of δ = 2.5 mm. 2D-3D registration was significantly faster with significantly less additional radiation necessary: 0.45 ± 0.28 vs 45.7 ± 9.1 Gy·cm2 in the 3D-3D cohort (P < .001); 2.3 ± 1.3 vs 5.3 ± 4.3 minutes in the 3D-3D cohort (P < .001). CONCLUSIONS Fusion imaging during EVAR with the use of 2D-3D registration is feasible in routine EVAR. Our findings of two consecutive cohorts with the same clinical, hardware, and software setup used for the procedures underscore that the accuracy of 2D-3D registration is noninferior to that of a 3D-3D registration workflow, with advantages in terms of radiation exposure, intraoperative time demand, and ease of use.
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Affiliation(s)
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany.
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9
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Koutouzi G, Pfister M, Breininger K, Hellström M, Roos H, Falkenberg M. Iliac artery deformation during EVAR. Vascular 2019; 27:511-517. [PMID: 30917751 DOI: 10.1177/1708538119840565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To quantify the deformation of the common iliac artery caused by stiff guide wires and delivery systems during abdominal endovascular aortic repair (EVAR). Methods Twenty-two patients treated with abdominal EVAR were included. The following three image data-sets were acquired for each patient: (1) a preoperative computed tomography angiography (CTA), (2) an intraoperative contrast-enhanced cone beam CT (CBCT) obtained after the main trunk of the bifurcated stent graft was released and both iliac limbs were engaged with stiff guide wires, and (3) the first postoperative CTA. These data-sets were merged and compared in an image analysis work station. The length and the tortuosity index of the common iliac artery, the Euclidian displacement of the aortic and the iliac bifurcations, and the optimal C-arm angulation for projection of the iliac bifurcation were computed. Results The common iliac artery was on average 6.4 mm shorter ( p < 0.001) and tortuosity index was lower ( p = 0.003) in the intraoperative images compared to preoperative. Some of the foreshortening was reversed postoperatively, remaining mean length difference was 2.9 mm ( p = 0.007) compared to preoperative. Intraoperatively, the aortic bifurcation was mostly displaced in a cranial direction (100%) and the iliac bifurcation in a ventral direction (93%). The optimal lateral C-arm angulation for projection of the iliac bifurcation changed. Anterior contralateral angle increased from median 42° (IQR, 27–63) in the preoperative CTA to 62 (49–74) in the intraoperative CBCT ( p = 0.02). Optimal cranio-caudal angulation did not change. Conclusion Stiff guide wires and delivery systems cause significant deformation of the common iliac arteries during EVAR. The aortic bifurcation is more cranial, the common iliac arteries are shorter, and optimal C-arm angulation is more contralateral oblique when the iliac limbs are to be deployed compared to baseline measurements from preoperative CTA. This affects image fusion accuracy and stent graft selection.
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Affiliation(s)
- Giasemi Koutouzi
- Department of Radiology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Katharina Breininger
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Roos
- Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mårten Falkenberg
- Department of Radiology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Tinelli G, De Nigris F, Minelli F, Flore R, Santoliquido A, Tshomba Y. Endoanchors under 3D image fusion for a type IA endoleak after EVAR. Clin Case Rep 2019; 7:529-532. [PMID: 30899487 PMCID: PMC6406156 DOI: 10.1002/ccr3.2033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022] Open
Abstract
The Heli-FX technique for type IA EL under 3D-IF proved to be accurate in terms of EL channel vision and correct endoanchors deployment. The EL volume rendering constant view allowed a precise anchors fixation at the EL channel. 3D-IF confirmed to be a valid help in orientation and navigation during endovascular aortic procedure.
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Affiliation(s)
- Giovanni Tinelli
- Vascular Surgery UnitFondazione Policlinico Univeristario A. Gemelli IRCCS, Roma ‐ Università Cattolica del Sacro CuoreRomeItaly
| | - Francesca De Nigris
- Vascular Surgery UnitFondazione Policlinico Univeristario A. Gemelli IRCCS, Roma ‐ Università Cattolica del Sacro CuoreRomeItaly
| | - Fabrizio Minelli
- Vascular Surgery UnitFondazione Policlinico Univeristario A. Gemelli IRCCS, Roma ‐ Università Cattolica del Sacro CuoreRomeItaly
| | - Roberto Flore
- Internal MedicineFondazione Policlinico Univeristario A. Gemelli IRCCS, Roma ‐ Università Cattolica del Sacro CuoreRomeItaly
| | - Angelo Santoliquido
- Internal MedicineFondazione Policlinico Univeristario A. Gemelli IRCCS, Roma ‐ Università Cattolica del Sacro CuoreRomeItaly
| | - Yamume Tshomba
- Vascular Surgery UnitFondazione Policlinico Univeristario A. Gemelli IRCCS, Roma ‐ Università Cattolica del Sacro CuoreRomeItaly
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Kaladji A, Villena A, Pascot R, Lalys F, Daoudal A, Clochard E, Lucas A, Cardon A. Fusion Imaging for EVAR with Mobile C-arm. Ann Vasc Surg 2019; 55:166-174. [DOI: 10.1016/j.avsg.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 01/08/2023]
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12
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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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13
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Barral PA, De Masi-Jacquier M, Gaudry M, Boutboul D, Bartoli JM, Jacquier A, Piquet P. Three-Dimensional to Three-Dimensional Image Fusion-Guided Thoracic Endovascular Aortic Repair without Iodine Injection. J Vasc Interv Radiol 2017; 28:1201-1203. [PMID: 28735942 DOI: 10.1016/j.jvir.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Pierre-Antoine Barral
- Hôpital La Timone Service d'Imagerie Médicale, 264, rue Saint-Pierre, Marseille 13005 France
| | | | - Marine Gaudry
- Service de Chirurgie Vasculaire, 264, rue Saint-Pierre, Marseille 13005 France
| | | | - Jean-Michel Bartoli
- Hôpital La Timone Service d'Imagerie Médicale, 264, rue Saint-Pierre, Marseille 13005 France
| | - Alexis Jacquier
- Hôpital La Timone Service d'Imagerie Médicale, 264, rue Saint-Pierre, Marseille 13005 France
| | - Philippe Piquet
- Service de Chirurgie Vasculaire, 264, rue Saint-Pierre, Marseille 13005 France
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15
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Gallitto E, Faggioli G, Gargiulo M, Freyrie A, Pini R, Mascoli C, Ancetti S, Vento V, Stella A. Planning, Execution, and Follow-up for Endovascular Aortic Aneurysm Repair Using a Highly Restrictive Iodinated Contrast Protocol in Patients with Severe Renal Disease. Ann Vasc Surg 2017. [PMID: 28648650 DOI: 10.1016/j.avsg.2017.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The cumulative amount of iodinated contrast medium necessary for endovascular repair (EVAR) planning, operative procedure, and subsequent follow-up is a threat for the onset of end-stage renal disease in patients with preoperative impaired kidney function. The purpose of this study was to describe a mini-invasive approach aimed to minimize the exposure of these patients to iodinated contrast medium and the subsequent risk of renal function worsening. METHODS From 2012 to 2015, all patients with abdominal aortic aneurysm (AAA) at high surgical risk and fit for standard EVAR (simple aortic-iliac anatomy: proximal and distal neck length ≥15 mm, no severe angulation), underwent EVAR through the following "near-zero contrast" approach, if their glomerular filtration rate (GFR) was <30 mL/min: preoperative planning was performed by noncontrast-enhanced computed tomography and duplex ultrasound (DU); the origin of renal/hypogastric arteries and aortic bifurcation was evaluated and matched with vertebral bone landmarks and the endograft deployed accordingly, using <20 cc of isotonic iodinate contrast medium and contrast-enhancement DU (CEUS). Follow-up was by DU/CEUS at 1, 6, and 12 months. Primary end points were technical success (TS: renal/hypogastric artery patency, absence of type I/III endoleaks, iliac stenosis/kinking, intraoperative mortality, and conversion), 30-day mortality, and new onset of permanent dialysis with renal function evaluation at 1, 6, and 12 months. Secondary end points were type II endoleaks, reinterventions, AAA, and renal-related mortality during the follow-up. RESULTS Eighteen patients (median age: 74 years, interquartile range [IQR]: 6, male: 78%, American Society of Anaesthesiologists [ASA] IV: 100%) were enrolled. The median AAA diameter and preoperative GFR were 66 mm (IQR: 13) and 22 mL/min (IQR: 4), respectively. Infrarenal (n = 10) and suprarenal fixation (n = 8) endografts were implanted, with a mean dose of iodinate contrast medium injection of 18 mL (IQR) and 100% TS rate. Two type II endoleaks were detected at the completion CEUS. The median postoperative GFR was 22 mL/min (IQR: 5). No patients had GFR worsening ≥30% at 1 day and 30 days. The 30-day mortality was 11% (2 deaths for heart failure). At a median follow-up of 16 months (IQR: 8), no patients needed hemodialytic treatment and no endoleaks were detected. One patient died at 6 months for cancer and one at 13 months for myocardial infarction. No reinterventions or AAA and renal-related mortality occurred during the follow-up. CONCLUSIONS A "near-zero contrast" approach is feasible in EVAR for patients with simple aorto-iliac anatomy. Patients with very poor renal function may still undergo to successful procedures, avoiding renal function impairment.
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Affiliation(s)
- Enrico Gallitto
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Gianluca Faggioli
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Antonio Freyrie
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rodolfo Pini
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Mascoli
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Ancetti
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Vincenzo Vento
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Stella
- Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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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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17
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Gindre J, Bel-Brunon A, Rochette M, Lucas A, Kaladji A, Haigron P, Combescure A. Patient-Specific Finite-Element Simulation of the Insertion of Guidewire During an EVAR Procedure: Guidewire Position Prediction Validation on 28 Cases. IEEE Trans Biomed Eng 2017; 64:1057-1066. [DOI: 10.1109/tbme.2016.2587362] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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18
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Diaphragm height varies with arm position: comparison between angiography and CT. Jpn J Radiol 2016; 34:724-729. [PMID: 27613643 DOI: 10.1007/s11604-016-0579-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate how elevation of the arms affects diaphragm height. MATERIALS AND METHODS We retrospectively reviewed angiography and computed tomography (CT) portography data from 44 patients who were treated for hepatocellular carcinoma at our institution from July 2013 to May 2014. Diaphragm height was determined independently by two radiologists as the distance from the upper edge of the first lumbar vertebra to the highest point of the right diaphragm. The differences in height between angiography and CT images were compared using a paired t-test. We also evaluated the influence of table height and distance between X-ray tube and flat panel detector [source-image distance (SID)] on a phantom model. RESULTS Diaphragm height was higher on CT images [mean ± standard deviation (SD), 113.2 ± 27.2 mm] than on angiography images (105.5 ± 27.8 mm; P < 0.001). Inter-rater correlation was excellent both in angiography (R = 0.920; P < 0.001) and CT (R = 0.950; P < 0.001) measurements. Table height and SID had no influence on diaphragm height measurements (P = 0.33). CONCLUSION The diaphragm elevation was observed on CT with arm elevation compared with angiography without arm elevation.
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Schulz CJ, Schmitt M, Böckler D, Geisbüsch P. Fusion Imaging to Support Endovascular Aneurysm Repair Using 3D-3D Registration. J Endovasc Ther 2016; 23:791-9. [DOI: 10.1177/1526602816660327] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: To evaluate the feasibility and accuracy of fusion imaging (FI) during endovascular aneurysm repair (EVAR). Methods: FI was performed in 101 consecutive EVAR patients (median age 72 years; 93 men) using automatic registration of the preoperative computed tomography angiography (CTA) with an intraoperative noncontrast cone beam CT (nCBCT; 3D-3D registration). Operative landmarks defined on the CTA were then overlaid in 3 dimensions on fluoroscopy images. Accuracy was measured as the deviation of the position of the lowest renal artery between the FI and angiography. Factors potentially influencing accuracy (α angle, β angle, anesthesia, tortuosity index, neck calcification, neck length, CTA slice thickness, and conventional or sac sealing stent-graft) were analyzed in a multivariate linear regression model. Results: Median procedure time for nCBCT was 3 minutes (range 2–20), with 4 minutes (range 0.4–15) for registration. An automatic registration tool was used successfully in 90 (89%) patients. Median craniocaudal deviation of the FI was 3 mm (range 0–15). Full accuracy (<1-mm deviation) was seen in 23 (23%) patients, 1- to 3-mm deviation in 23 (23%), 4- to 5-mm deviation in 22 (22%), and >5-mm deviation in 33 (33%). Caudal deviation potentially resulting in renal coverage was seen in 9 (9%). Lateral plus craniocaudal deviation was a median 5.8 mm (range 0–22). The position of the lowest renal artery compared to the FI was left and cranial in 62 (61%). Aneurysm morphology (β angle, p=0.04), CTA slice thickness (p=0.02), and the use of 2 stiff guidewires in endovascular aneurysm sealing (p=0.01) influenced the overlay accuracy. Conclusion: Fusion imaging can be integrated into a daily workflow adding little to the procedure time. Craniocaudal accuracy (<5 mm) was achieved in 68% of cases, allowing optimal C-arm and angiographic catheter positioning or cannulation of target vessels in most patients. However, the accuracy of FI does not allow a noncontrast EVAR procedure without confirmation of FI overlay by a minimal contrast injection or vessel cannulation.
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Affiliation(s)
- Christof J. Schulz
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Matthias Schmitt
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
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Ahmad W, Gawenda M, Brunkwall S, Shahverdyan R, Brunkwall JS. Endovascular Aortoiliac Aneurysm Repair with Fenestrated Stent Graft and Iliac Side Branch Using Image Fusion without Iodinated Contrast Medium. Ann Vasc Surg 2016; 33:231.e5-9. [DOI: 10.1016/j.avsg.2015.11.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/14/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
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21
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Schulz CJ, Schmitt M, Böckler D, Geisbüsch P. Feasibility and accuracy of fusion imaging during thoracic endovascular aortic repair. J Vasc Surg 2015; 63:314-22. [PMID: 26527424 DOI: 10.1016/j.jvs.2015.08.089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate accuracy and feasibility of fusion imaging during thoracic endovascular aortic repair (TEVAR). METHODS From January 2013 to January 2015 fusion imaging was used in 18 TEVAR procedures. Patients were prospectively enrolled for the survey and informed consent was obtained. Planning of the procedure and computed tomography (CT) angiography (CTA) segmentation with determination of all relevant surgical landmarks that should be displayed on fusion imaging was done using the preoperative CTA data. The registration was done with an intraoperative noncontrast-enhanced cone beam CT and CTA (three-dimensional [3D]-3D registration; n = 15) or with two fluoroscopic images in anteroposterior and lateral projection and the CTA (two-dimensional-3D registration; n = 3). An intraoperative digital subtraction angiography was performed to adjust fusion imaging and to allow accuracy measurement. RESULTS Fusion imaging was possible in all included patients. The median dose for noncontrast-enhanced cone beam CT imaging was 28.6 Gy/cm(2) (range, 17.9-43.3) and 0.46 Gy cm(2) for two fluoroscopic images in the two-dimensional-3D group. Full accuracy was achieved in two cases (11%), with a median deviation of 11.7 mm (range, 0.0-37.2). Manual realignment was possible in all cases. CONCLUSIONS This early experience shows that fusion imaging is feasible in TEVAR procedures using different registration methods. However, it shows a significant deviation in thoracic procedures because of different sources of error, making confirmation of fusion overlay with a digital subtraction angiography necessary in any case.
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Affiliation(s)
- Christof Johannes Schulz
- Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Schmitt
- Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany.
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