FT1. Utility of Intraoperative Cone Beam Computed Tomography in Endovascular Treatment of Aortoiliac Occlusive Disease

Abstract

Endovascular treatment of aortoiliac occlusive disease (AIOD) is well established, but secondary interventions are not uncommon to maintain long-term patency. Multiple stents and iliac artery tortuosity often make it difficult to evaluate stent compressions intraoperatively, and this might be a cause for later failure. Completion angiogram (CA) and pressure gradient (PG) measurement are often used to control the final intraoperative result. The purpose for this study was to evaluate the intraoperative outcome by cone beam computed tomography (CBCT) in order to optimize the primary operation results. Fifty-three patients (28 females) were enrolled in a prospective study. All patients underwent aortoiliac revascularization. Final intraoperative results were evaluated with additional CBCT after CA and PG were found satisfactory. Imaging findings and imaging-based adjunctive procedures were recorded. A total of 165 stents were placed due to AIOD. Twenty-six of 53 patients had kissing stents were placed in the aortoiliac bifurcation. Twenty-one patients underwent adjunctive procedures after the primary stenting. In 24.5% (13 of 53) cases, adjunctive procedures were indicated solely by the CBCT findings, because both standard CA and PG were normal. Adjunctive procedures were needed in 38.5% of the kissing stent patients, and in six of 10, these stent compressions were detected only by CBCT. The use of CBCT revealed a significant number of stent compressions that were not found with CA and PG. Particularly in patients receiving kissing stents, CBCT seemed to be beneficial. In this study, CBCT improved the technical results intraoperatively, which might influence the long-term patency positively.