title: EVAR Guided by 3D Image Fusion and CO2 DSA: A New Imaging Combination for Patients With Renal Insufficiency.
abstract: OBJECTIVE
  To present a new combination of imaging techniques that helps reduce the use of iodinated contrast during endovascular aneurysm repair (EVAR) procedures in patients with renal insufficiency.
  
  
  METHODS
  Relevant anatomical structures are marked in the preprocedure computed tomography (CT) angiogram. A 3D-3D image fusion between the preprocedure CT and an intraprocedure cone-beam CT is performed in order to overlay anatomical information on live fluoroscopy. Verification of the correct overlay matching (or adjustment if necessary) is based on carbon dioxide (CO2) digital subtraction angiograms (DSA) instead of iodine DSA. The stent-graft is placed and deployed based on the overlaid information. Correct device placement is finally verified with conventional contrast angiography.
  
  
  CONCLUSIONS
  The combination of 3D image fusion of a preoperative CT with live fluoroscopy and CO2 DSA verification is feasible and sufficient for guidance of abdominal EVAR. This method minimizes the use of iodinated contrast media, protecting residual function in the setting of preexisting renal insufficiency.
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden giasemi.koutouzi@vgregion.se.
authors.forename: Giasemi
authors.initials: G
authors.lastname: Koutouzi
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Henrikson
authors.affiliation: Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Roos
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Zachrisson
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Falkenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002245:Carbon Dioxide; D003287:Contrast Media; D057510:Endovascular Procedures; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D064847:Multimodal Imaging; D051437:Renal Insufficiency / Q000150:complications; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide
keywords: 3D image fusion; carbon dioxide angiography; digital subtraction angiography; endovascular aneurysm repair; image guidance; renal failure