Intraoperative contrast-enhanced cone beam computed tomography to assess technical success during endovascular aneurysm repair.
BACKGROUND
The aim of the study was to analyze the use of contrast-enhanced cone beam computed tomography (ceCBCT) during endovascular aneurysm repair (EVAR) and to compare this imaging modality with standard completion digital subtraction angiography (cDSA) and postoperative computed tomography angiography (CTA) regarding the detection of endograft-associated complications.


METHODS
Between September 2012 and April 2015, ceCBCT was used in 98 EVAR patients in addition to cDSA and CTA. Endoleaks, intraluminal thrombus and limb stenoses, contrast agent use, and radiation exposure were recorded for all modalities.


RESULTS
cDSA detected 16 (16.3%) endoleaks; ceCBCT, 35 (35.7%) endoleaks; and CTA, 22 (22.4%) endoleaks. All endoleaks identified by cDSA or CTA were also seen on ceCBCT. ceCBCT detected intraluminal thrombus in three patients (none in cDSA or CTA) and previously undetected limb stenoses in three patients. It prompted intraoperative interventions in 7 of 98 patients (7.1%). Replacing cDSA and CTA by ceCBCT would have caused a 39% reduction of in-hospital contrast agent volume in this cohort.


CONCLUSIONS
ceCBCT can reliably detect all endograft-associated complications during EVAR. It offers the chance for immediate revision of remediable problems in a relevant proportion of patients and could thus reduce early reintervention rates. ceCBCT can safely replace early follow-up CTA and thereby reduce in-hospital use of contrast media.
Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany.
Christof Johannes
CJ
Schulz
Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany.
Matthias
M
Schmitt
Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany. Electronic address: dittmar.boeckler@med.uni-heidelberg.de.
Dittmar
D
Böckler
Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany.
Philipp
P
Geisbüsch
D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D054893:Cone-Beam Computed Tomography; D003287:Contrast Media / Q000008:administration & dosage*; D057867:Endoleak / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide