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Objectives Endovascular surgery has revolutionized the treatment of aortic aneurysms; however these improvements have come at the cost of increased radiation and contrast exposure, particularly for more complex procedures. Three dimensional (3D) fusion computed tomographic (CT) imaging is a new technology that may facilitate these repairs. The purpose of this analysis was to determine the impact of utilizing intraoperative 3D fusion CT on performance of fenestrated endovascular aortic repair. Methods A review of our institutional database was performed to identify patients undergoing fenestrated/branched endovascular aortic repair (FEVAR). Subjects treated using 3D fusion CT were compared to patients treated in the immediate 12-month period prior to implementation of this technology when procedures were performed in a standard hybrid operating room without CT fusion capabilities. Primary endpoints included patient radiation exposure (air kerma area product: milliGray; mGy*cm2), fluoroscopy time (minutes; min), contrast usage (mL) and procedure time (min). Patients were grouped by number of aortic graft fenestrations revascularized with a stentgraft and operative outcomes were compared. Results A total of 72 patients (N = 41 before vs. N = 31 after 3D fusion CT implementation) underwent FEVAR from September 2012 through March 2014. For 2-vessel fenestrated endografts, there was a significant decrease in radiation exposure (3400±1900 vs. 1380±520 mGy*cm2; P=.001), fluoroscopy time (63±29 vs. 41±11min; P=.02), and contrast usage (69±16 vs. 26±8 mL; P=.0002) with intraoperative 3D fusion CT. Similarly, for combined 3 and 4-vessel FEVAR, significantly decreased radiation exposure (5400±2225 vs. 2700±1400 mGy*cm2; P<.0001), fluoroscopy time (89±36 vs 6±21min; P=.02), contrast usage (90±25 vs. 39±17mL; P<.0001), as well as procedure time (330±100 vs. 230±50min; P=.002) was noted. Estimated blood loss was significantly less (P<.0001) and length of stay had a trend (P=.07) toward being lower for all patients in the 3D CT group. Conclusions These results demonstrate that use of intraoperative 3D fusion CT imaging during FEVAR can significantly decrease radiation exposure and procedure time, as well as contrast usage, which may also decrease the overall physiologic impact of the repair.

With respect to both clinical outcome measures and subsequent resource utilization, statin therapy is associated with a beneficial effect in patients undergoing elective AAA repair. These data suggest that preoperative statin therapy should be an integral part of the risk optimization for patients undergoing AAA repair.

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