Abstract No. 644 Venous intervention guidance with overlay of 3D vessel center lines from preoperative CT/MR imaging

Abstract

Deep vein thrombosis (DVT) recanalization cases can be time intensive, often requiring extensive fluoroscopic evaluation, contrast use, and repeat interventions. Contrast based roadmapping for device navigation is highly variable in delineating boundaries of chronically occluded vein segments. Improving operator confidence in catheter guidance through vascular occlusions is therefore invaluable in minimizing procedural time and radiation exposure. Pre-procedural diagnostic information is typically acquired prior to DVT recanalization (cross-sectional CT/MR venography). The purpose of this study is to evaluate the feasibility of utilizing center lines from preoperative imaging during traversal of DVT occlusions and overlay of data with real-time fluoroscopy (Vessel ASSIST, GE Healthcare). Following institutional IRB application, clinical and imaging parameters from patients were reviewed (6 with ileiocaval stenosis/occlusive DVT). Dedicated IR clinic consultations were performed (ileiocaval patients CEAP scores >C2). All patients underwent preprocedural CT/MR venography prior to interventions. Vessel mapping to direct catheter navigation was utilized in all cases. Center line of occluded vessels were mapped prior to cases and registered to the patient using landmarks such as pelvic bones (with CT) or femoral heads (with MR) to assist with catheter navigation through occluded veins. Procedures were performed on the GE Discovery IGS 740 hybrid fluoroscopy system. All ileiocaval vein catherizations performed utilizing vessel center line 3D overlay were successful. No procedural complications related to utilization of software for catheter navigation. Significant ease of comfort navigating vasculature comparable to use of contrast-based roadmaps was reported. No errors or difficulty in overlay setup reported by IR technologists. 3D overlay with vessel tracking from preprocedural cross-sectional imaging data for ileiocaval catheter navigation is technically feasible, noting decreases in contrast use compared to conventional venography. While our data supports continued use of this technology, further prospective evaluation of this roadmapping technique is warranted.