Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

J Barkhausen,E Stahlberg,M Wiedner,Susanne Anton,M Planert,Janpeter Goltz,M Sieren

doi:10.31487/j.rdi.2019.04.02

Abstract

Background: Standard endovascular aortic repair (EVAR) is frequently performed with few data regarding utilization of 2D-3D fusion imaging (FI). Purpose: To evaluate a) feasibility and safety of 2D-3D FI to guide limb deployment during EVAR and b) efficacy of this technique compared to standard use of digital subtraction angiography (DSA) for guidance. Materials and Methods: Iliac limb deployment by guidance of 2D-3D FI (FUSION group, n=22 limbs) during EVAR was compared to (STANDARD group, n=23 limbs). Retrospectively, we analyzed feasibility (success-rate) and safety (patency of hypogastric artery; type Ib/III endoleak) of FI for limb deployment (FUSION group). Total contrast (ml) and median dose area product (mGy*cm2) per group to visualize the iliac bifurcation were compared. Results: In the FUSION group, limb deployment was performed in 19/22 limbs (86.4%) and all hypogastric arteries were patent at the end of the procedure. Median volumes of contrast per bifurcation were 13.0 ml (RANGE 13–13ml) in the STANDARD and 2.2ml (RANGE 0–13ml) in the FUSION group (p=0.002); median dose area products per bifurcation were 11951mGy*cm2 and 2593.1mGy*cm2 (p=0.001), respectively. Conclusion: Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions. Therefore, FI should be used whenever possible

Highlights

To evaluate a) feasibility and safety of 2D-3D fusion imaging (FI) to guide limb deployment during endovascular aortic repair (EVAR) and b) efficacy of this technique compared to standard use of digital subtraction angiography (DSA) for guidance
Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions
Since introduction of endovascular aortic repair (EVAR) it has evolved as the first-line therapy of infra-renal abdominal aortic aneurysms (AAA) for suitable anatomies [1]

Summary

Introduction

Since introduction of endovascular aortic repair (EVAR) it has evolved as the first-line therapy of infra-renal abdominal aortic aneurysms (AAA) for suitable anatomies [1]. It seems important to reduce both radiation and contrast exposure during EVAR In this context fusion imaging (FI) has been introduced recently to guide endovascular procedures. We recently reported the implementation of calculating C-arm positions prior to standard EVAR procedures and found a significant reduction of contrast and radiation exposure [13] In this context, as new FI techniques are emerging, we evaluate the feasibility and safety of peri-interventional FI during standard EVAR procedures in combination with pre-interventional calculation of C-arm positions [14]. Conclusion: Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions.

Methods

Results

Conclusion