CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair.
OBJECTIVE
To evaluate the effect of intraoperative guidance by means of live fluoroscopy image fusion with computed tomography angiography (CTA) on iodinated contrast material volume, procedure time, and fluoroscopy time in endovascular thoraco-abdominal aortic repair.


METHODS
CTA with fluoroscopy image fusion road-mapping was prospectively evaluated in patients with complex aortic aneurysms who underwent fenestrated and/or branched endovascular repair (FEVAR/BEVAR). Total iodinated contrast material volume, overall procedure time, and fluoroscopy time were compared between the fusion group (n = 31) and case controls (n = 31). Reasons for potential fusion image inaccuracy were analyzed.


RESULTS
Fusion imaging was feasible in all patients. Fusion image road-mapping was used for navigation and positioning of the devices and catheter guidance during access to target vessels. Iodinated contrast material volume and procedure time were significantly lower in the fusion group than in case controls (159 mL [95% CI 132-186 mL] vs. 199 mL [95% CI 170-229 mL], p = .037 and 5.2 hours [95% CI 4.5-5.9 hours] vs. 6.3 hours (95% CI 5.4-7.2 hours), p = .022). No significant differences in fluoroscopy time were observed (p = .38). Respiration-related vessel displacement, vessel elongation, and displacement by stiff devices as well as patient movement were identified as reasons for fusion image inaccuracy.


CONCLUSIONS
Image fusion guidance provides added value in complex endovascular interventions. The technology significantly reduces iodinated contrast material dose and procedure time.
Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: anni.sailer@mumc.nl.
A M
AM
Sailer
Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
M W
MW
de Haan
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
A G
AG
Peppelenbosch
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
M J
MJ
Jacobs
Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
J E
JE
Wildberger
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
G W H
GW
Schurink
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000295:instrumentation / Q000379:methods; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D003287:Contrast Media / Q000627:therapeutic use; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged
D003287:Contrast Media
Computed tomography angiography; FEVAR/BEVAR; Fluoroscopy; Iodinated contrast material; Multimodality image fusion; Road-map