Abstract
IntroductionEndovascular aneurysm repair requires the precise deployment of the graft. In order to achieve accurate positioning, the anatomical and morphological characteristics of the aorta and its branches is mandatory. Software that perform three dimensional reformatting of multislice tomographic images, allow for the study of the whole aorto-iliac axis and the perpendicular visualization of the origin of the renal arteries. The correct length of the proximal neck can be evaluated and adequate graft fixation and sealing may be foreseen. A technique is presented, using an software, for the orthogonal correction of the position of the renal arteries in relation to the proximal neck, which may guide the radioscopic orientation intraoperatively.MethodsWithin a multiplanar tomographic image reconstruction, virtual triangulation allows for the three dimensional orthogonal correction of the renal arteries' ostia position. The predetermined best angulations for visualization are annotated and used for the positioning of the surgical C-arm.Results/DiscussionSome authors discuss that the anatomic position of the renal vessels seen on the tomographic scan can change during the surgical procedure. It is known that the renal arterys' angular positioning does not alter, even after insertion of stiff guidewires, introducers, and the endograft itself. Therefore, it is possible, using concepts of spacial geometry and orthogonal correction, to predict the ideal bidimensional intraoperative positioning of the radioscopy device in order to reproduce the optimized renal artery ostial projection, ensuring the best accuracy during endograft deployment.ConclusionAs closer to the tomographic reproduction was the radioscopic correction, more careful is the visualization of the ostium of the renal artery, better is the exploitation of the lap for fixing and sealing and the endoprosthesis deployment is more accurate.
Highlights
Endovascular aneurysm repair requires the precise deployment of the graft
As closer to the tomographic reproduction was the radioscopic correction, more careful is the visualization of the ostium of the renal artery, better is the exploitation of the lap for fixing and sealing and the endoprosthesis deployment is more accurate
With the enhancement of information technology, the study of helical biplane CT scans associated with complementary marked catheter aortography was replaced by the use of computed tomography (CT) multichannel, with cuts in smaller thicknesses and with greater detail that, when associated with three dimensions (3D) reconstruction software, allow the scanned virtual reproduction of the patient and his anatomy [2]
Summary
Endovascular aneurysm repair requires the precise deployment of the graft. In order to achieve accurate positioning, the anatomical and morphological characteristics of the aorta and its branches is mandatory. Methods: Within a multiplanar tomographic image reconstruction, virtual triangulation allows for the three dimensional orthogonal correction of the renal arteries' ostia position. CT and angiography (angioTC) have an essential role in preinterventional planning and control of the procedure and is considered the test of choice in assessing the candidate patient to envodascular treatment and for his monitoring in search of complications [3] These reconstructions allow rapid assessment of the extent of the aneurysm, visceral involvement, presence of angulation, tortuosity and access difficult. An accurate analysis of the axial, coronal and sagittal sections enables the planning of the type of stent to be used This is achieved with the use of reconstruction methods available in software such as multiplanar reconstruction (MPR and MPR - Curved), maximum intensity projection (MIP) and 3D image reconstruction volume
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