Intra-operative cone beam computed tomography can help avoid reinterventions and reduce CT follow up after infrarenal EVAR.
OBJECTIVE
Re-interventions after endovascular abdominal aortic aneurysm repair (EVAR) are common and therefore a strict imaging follow up protocol is required. The purpose of this study was to evaluate whether cone beam computed tomography (CBCT) can detect intra-operative complications and to compare this with angiography and the 1 month CT follow up (computed tomography angiography [CTA]).


METHODS
Fifty-one patients (44 men) were enrolled in a prospective trial. Patients underwent completion angiography and CBCT during infrarenal EVAR. Contrast was used except when pre-operative renal insufficiency was present or if the maximum contrast dose threshold was reached. CBCT reconstruction included the top of the stent graft to the iliac bifurcation. Endoleaks, kinks, or compressions were recorded.


RESULTS
CBCT was technically successful in all patients. Twelve endoleaks were detected on completion digital subtraction angiography (CA). CBCT detected 4/5 type 1 endoleaks, but only one type 2 endoleak. CTA identified eight type 2 endoleaks and one residual type I endoleak. Two cases of stent compression were seen on CA. CBCT revealed five stent compressions and one kink, which resulted in four intra-operative adjunctive manoeuvres. CTA identified all cases of kinks or compressions that were left untreated. Two of them were corrected later. No additional kinks/compressions were found on CTA. Groin closure consisted of 78 fascia sutures, nine cut downs, and 11 percutaneous sutures. Seven femoral artery pseudoaneurysms (<1 cm) were detected on CTA, but no intervention was needed.


CONCLUSIONS
CA is better than CBCT in detecting and categorizing endoleaks but CBCT (with or without contrast) is better than CA for detection of kinks or stentgraft compression. CTA plus CBCT identified all significant complications noted on the 1 month follow up CTA. The use of intra-operative CA and CBCT could replace early CTA after standard EVAR thus reducing overall radiation and contrast use. Technical development might further improve the resolution and usefulness of CBCT.
Vascular Center, Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Malmö, Sweden. Electronic address: tornqvist.pelle@gmail.com.
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Törnqvist
Vascular Center, Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Malmö, Sweden.
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Dias
Vascular Center, Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Malmö, Sweden.
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Sonesson
Vascular Center, Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Malmö, Sweden.
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Kristmundsson
Vascular Center, Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Malmö, Sweden.
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Resch
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003287:Contrast Media; D057867:Endoleak / Q000175:diagnosis / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color / Q000379:methods
D003287:Contrast Media
Cone beam CT; DynaCT; EVAR; Re-interventions