title: Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion.
abstract: OBJECTIVE
  To evaluate the feasibility of image fusion (IF) of preprocedural arterial-phase computed tomography with intraprocedural fluoroscopy for roadmapping in endovascular repair of complex aortic aneurysms, and to compare this approach versus current roadmapping methods (ie, two-dimensional [2D] and three-dimensional [3D] angiography).
  
  
  METHODS
  Thirty-seven consecutive patients with complex aortic aneurysms treated with endovascular techniques were retrospectively reviewed; these included aneurysms of digestive and/or renal arteries and pararenal and juxtarenal aortic aneurysms. All interventions were performed with the same angiographic system. According to the availability of different roadmapping software, patients were successively placed into three intraprocedural image guidance groups: (i) 2D angiography (n = 9), (ii) 3D rotational angiography (n = 14), and (iii) IF (n = 14). X-ray exposure (dose-area product [DAP]), injected contrast medium volume, and procedure time were recorded.
  
  
  RESULTS
  Patient characteristics were similar among groups, with no statistically significant differences (P ≥ .05). There was no statistical difference in endograft deployment success between groups (2D angiography, eight of nine patients [89%]; 3D angiography and IF, 14 of 14 patients each [100%]). The IF group showed significant reduction (P < .0001) in injected contrast medium volume versus other groups (2D, 235 mL ± 145; 3D, 225 mL ± 119; IF, 65 mL ± 28). Mean DAP values showed no significant difference between groups (2D, 1,188 Gy · cm(2) ± 1,067; 3D, 984 Gy · cm(2) ± 581; IF, 655 Gy · cm(2) ± 457; P = .18); nor did procedure times (2D, 233 min ± 123; 3D, 181 min ± 53; IF, 189 min ± 60; P = .59).
  
  
  CONCLUSIONS
  The use of IF-based roadmapping is a feasible technique for endovascular complex aneurysm repair associated with significant reduction of injected contrast agent volume and similar x-ray exposure and procedure time.
authors.affiliation: Medical Imaging Service, Interventional and Therapeutic Vascular and Oncologic Radiology Unit, Université Paris-Est Créteil, France.
authors.forename: Vania
authors.initials: V
authors.lastname: Tacher
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
authors.forename: Pascal
authors.initials: P
authors.lastname: Desgranges
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Deux
authors.forename: Thijs
authors.initials: T
authors.lastname: Grünhagen
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Becquemin
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.forename: Hicham
authors.initials: H
authors.lastname: Kobeiter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D015901:Angiography, Digital Subtraction; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation; D054893:Cone-Beam Computed Tomography; D003287:Contrast Media; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D061646:Operative Time; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D012984:Software; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: 2D; 3D; DAP; DSA; EVAR; FOV; IF; digital subtraction angiography; dose–area product; endovascular aneurysm repair; field of view; image fusion; three-dimensional; two-dimensional
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