Assessing radiation exposure to patients during endovascular treatment of chronic venous obstruction

Intraoperative completion cone-beam computed tomography for the assessment of residual lesions after primary treatment of proximal venous outflow obstructions

OBJECTIVE

Report the usefulness of completion cone-beam computed tomography (CBCT) as an adjunct tool during femoro-ilio-caval recanalization post stent placement.

METHODS

Data from patients who underwent complex endovenous recanalization for chronic proximal outflow obstruction from January 2018 to May 2020 were analyzed. Two groups of patients were obtained based on the execution or not of completion CBCT. Outcomes, radiation, and contrast doses in the two groups were compared.

RESULTS

Fifteen patients (9 female, mean age 46.9 ± 13.3) in the control group and ten patients (7 female, 58.3 ± 14) in the CBCT group were included. In the CBCT group, one patient underwent an intraprocedural revision due to a residual lesion. The median total kerma area product (KAP_total) and the total volume of contrast injected were not statistically different in the two groups.

CONCLUSIONS

Completion CBCT after endovenous procedures might identify residual stenosis or stent malposition without a significant increase of total contrast injected and KAP_total.

Intraprocedural guidance for recanalization of post-thrombotic venous lesions using live overlay of center lines from pre-operative cross-sectional imaging: a preliminary experience

Purpose

Pre-procedural contrast-enhanced CT and MRI imaging is typically acquired prior to deep venous recanalization procedures for post-thrombotic syndrome. This technical note reports the utility of live-overlay of augmented centerlines extracted from pre-procedural CT and MRI imaging in facilitating fluoroscopic-guided recanalization of post-thrombotic venous lesions.

Methods and materials

Six patients with pre-procedural CT or MR venography data were incorporated into a commercially available 3D overlay software (Vessel Assist, GE Healthcare, Buc, France) during venous disease interventions for post-thrombotic venous lesions. Procedures were performed on the GE Discovery IGS 740 fluoroscopy system. After manual determination of the vasculature from preprocedural CT or MR, centerlines were created representing the location and trajectory of the vessels. Steps showcasing the creation of centerlines and their representation during overlay with real-time fluoroscopic guidance in these cases are outlined. Time required to cross the post-thrombotic and occlusive venous segments were reviewed.

Results

All iliocaval recanalization procedures were successfully performed utilizing vessel centerline 3D overlay. In one case where occlusion extended to the femoral vein, mis-registration was identified over the femoral anatomy due to a complex leg rotation compared to pre-procedural imaging. No procedural complications related to utilization of software were noted. Average crossing time for occlusions was 3.4 min (range 1.6–5.2).

Conclusion

3D overlay with vessel tracking from pre-procedural CT and MRI imaging is technically feasible and assists in catheter navigation for post-thrombotic venous segments. While results from these preliminary experiences support the continued use of this technology, further prospective and comparative evaluation of this technique is warranted to assess for added value in technical success, reductions in procedure time or reductions in radiation exposure.