Abstract
PurposePre-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 materialsSix 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.ResultsAll 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).Conclusion3D 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.
Highlights
Recanalization of chronic deep venous obstructions or post-thrombotic venous segments can require extensive fluoroscopic time, contrast use, and repeat interventions (Barbati et al 2019)
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
Summary
Recanalization of chronic deep venous obstructions or post-thrombotic venous segments can require extensive fluoroscopic time, contrast use, and repeat interventions (Barbati et al 2019). Cases using an augmented vasculature model for venous recanalization have been reported previously (Chinnadurai and Bismuth 2018) In this patient cohort, poor contrast opacification due to chronic postthrombotic changes prevented adequate guidance for catheterization. Trajectories referred to as “centerlines” were created by using contrast-enhanced CT and MR imaging acquired prior to recanalization These centerlines corresponding to the location of the postthrombotic and often hypoplastic venous segment, as delineated by the interventional radiologist, can be superimposed on live fluoroscopy to improve vessel catheterization. This technical report highlights the feasibility of utilizing centerline fluoroscopy overlay from pre-operative CT and MR imaging during traversal of post-thrombotic venous lesions
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