Intra-operative DynaCT improves technical success of endovascular repair of abdominal aortic aneurysms.
OBJECTIVE
To evaluate feasibility, technical success, and the need for reintervention in the early perioperative period, following the introduction of intraoperative DynaCT (DynaCT, Siemens AG, Berlin, Germany) in patients undergoing infrarenal endovascular aneurysm repair (EVAR). DynaCT involves the generation of computed tomography (CT)-like images from "on table" rotational angiographic acquisition.


METHODS
A prospectively maintained database of 312 patients undergoing EVAR (September 2001 - February 2007) was interrogated to determine incidence of early reintervention following satisfactory appearances of uniplanar completion angiography (control group). Following the introduction of DynaCT (DynaCT group - 80 patients), clinical and radiologic outcomes were prospectively evaluated (September 2007 - May 2008). Both groups underwent pre-discharge computed tomographic angiography (CTA) and color-flow duplex scan. Comparative analysis of procedural data, hospital-stay, mortality, and early reintervention between the two groups was undertaken.


RESULTS
In the control group, 14 (4.5%) patients required reintervention procedures within 30 days of EVAR (10 endovascular, 7 surgical). Six patients had type 1 endoleaks and 8 presented with acute limb ischemia. Review of this cohort suggested that the majority of complications (86%) may have been immediately identifiable with improved intra-operative quality control. In the DynaCT group, DynaCT was feasible in 81.3% (n = 65/80) of patients and resulted in the detection of five clinically significant anomalies (6.25%, n = 5/80). These technical problems were not identified at completion angiography but were corrected after DynaCT (2 type 1 endoleaks, 1 type 3 endoleak, 1 limb compression, and 1 graft thrombosis). Standard pre-discharge imaging did not identify any further graft-related complications in the DynaCT group. Introduction of DynaCT resulted in a reduced need for early reintervention (0/80 vs 14/312, P = .05).


CONCLUSIONS
Most graft-related complications that mandate early reintervention following EVAR are due to remediable technical problems which are not identified by uniplanar completion angiography alone. DynaCT is a feasible intra-operative adjunct to completion angiography, which improves intra-operative quality control during endovascular repair of abdominal aortic aneurysms.
Biasi
Lukla
L
St George's Regional Vascular Institute, St Georges Hospital NHS Trust, London, United Kingdom.
Ali
Tahir
T
Ratnam
Lakshmi Arumagum
LA
Morgan
Rob
R
Loftus
Ian
I
Thompson
Matt
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D016022:Case-Control Studies; D019992:Databases as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D019984:Quality Indicators, Health Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000379:methods*; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color