Impact of the Endonaut® Angio-Navigation System on Radiation Exposure in Endovascular Aortic Repair Performed with Mobile C-Arms

Abstract

Fusion imaging systems have proved to reduce radiation exposure mostly in hybrid rooms but reports with mobile C-arms are few. The aim of this study was to analyze the impact of the Endonaut navigation system on radiation exposure in endovascular aneurysm repair (EVAR) performed with mobile C-arms. All patients undergoing EVAR and/or iliac branched devices implantation between January 2016 and August 2022 were included. All procedures were performed with a mobile C-arm (Siemens Avantic or GE Elite until March 2018, Siemens Cios Alpha thereafter). The Endonaut navigation system has been used since January 2021. Two groups were, therefore, compared: before (control group [CGr]) and after the use of Endonaut. Radiation data including Dose Area Product (DAP) values, Air Kerma (AK) and fluoroscopy time (FT) were collected retrospectively. Overall, 153 patients were included: CGr, n=121; Endonaut group (EnGr), n=32. No significant difference was found between the 2 groups regarding demographic data. DAP values were significantly lower in the EnGr (38Gycm2±24) vs. the CGr (76Gycm2±51) (P<0.05) despite a significantly higher number of complex procedures such as iliac branched devices (P<0.05). AK values were not significantly different between the EnGr and the CGr (196mGy±114 vs. 209mGy±138) as well as FT (33minutes±18 vs. 33minutes±16). Technical success was 97% (31/32) in the EnGr vs. 96% (116/121) in the CGr (P=0.79). The volume of contrast media was significantly lower in the EnGr (94cc±41) vs. the CGr (143cc±66) (P<0.05). In this study, the use of the Endonaut angio-navigation system when performing EVAR with mobile C-arms led to a radiation dose reduction without compromising technical success or procedural time.