Use of preoperative magnetic resonance angiography and the Artis zeego fusion program to minimize contrast during endovascular repair of an iliac artery aneurysm.
BACKGROUND
A 61-year-old man with a previous endovascular repair and stage 5 chronic kidney disease presented with a symptomatic 4.5-cm left internal iliac artery aneurysm. The decision was made to proceed with endovascular repair.


METHODS
The preoperative magnetic resonance angiography (MRA) scan was linked to on-table rotational imaging using the Artis zeego Fusion program (Siemens AG, Forchheim, Germany). Using the fused image as a road map, we undertook coil embolization of the left internal iliac artery, and a tapered stent graft was extended from the previous graft into the external iliac artery.


RESULTS
Completion angiography revealed exclusion of the aneurysm sac. Three milliliters of contrast were used throughout the procedure. A follow-up magnetic resonance angiography scan at 1 month and duplex ultrasonography at 1 year revealed continued exclusion of the aneurysm sac. The patient's renal function remained unchanged.


CONCLUSIONS
This case shows that in a patient with severe chronic kidney disease, fusion of preoperative imaging with intraoperative rotational imaging is feasible and can limit significantly the amount of contrast used during a complex endovascular procedure.
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY. Electronic address: neal.cayne@nyumc.org.
Mikel
M
Sadek
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Todd L
TL
Berland
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Thomas S
TS
Maldonado
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Caron B
CB
Rockman
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Firas F
FF
Mussa
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Mark A
MA
Adelman
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Frank J
FJ
Veith
Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
Neal S
NS
Cayne
D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D003287:Contrast Media / Q000009:adverse effects; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000295:instrumentation; D005682:Gadolinium / Q000009:adverse effects; D006571:Heterocyclic Compounds / Q000009:adverse effects; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011474:Prosthesis Design; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis; D012984:Software; D015607:Stents; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium