A prospective observational trial of fusion imaging in infrarenal aneurysms

Maurel, Blandine; Martin-Gonzalez, Térésa; Chong, Debra; Irwin, A. G.; Guimbretière, Guillaume; Davis, Meryl; Mastracci, Tara M.

doi:10.1016/j.jvs.2018.04.015

Cited by 40 publications

(25 citation statements)

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“…Precise graft placement and complete exclusion of the aneurysm sac is the key to successful endovascular repair. CBCT and fusion technology allow better visualization of the 3D aortic sac and its branches which allows precise graft placement at lower radiation doses [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…There are clear advantages of using fusion imaging, which allows cannulation of visceral and renal branches without using angiography using the fusion map. This lowers radiation exposure as well as contrast dose used [6,7]. Standard infrarenal EVAR using a mobile C-arm has shown to increase radiation exposure to both the patient and the provider.…”

Section: Discussionmentioning

confidence: 99%

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Safety and Feasibility of Performing Fenestrated Endovascular Abdominal Aneurysm Repair Using a Portable C-arm Without Fusion Technology: A Single-Center Experience

Juneja

Zia

Ayad

et al. 2020

Cureus

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Most centers performing fenestrated endovascular aneurysm repair (F-EVAR) use hybrid rooms with fusion technology for mapping. We present our experience of successfully performing F-EVAR using C-arm without fusion technology. Methods During the period of January 2016 to October 2018, data were collected from a prospectively maintained F-EVAR database at our tertiary care institute. The primary endpoint was technical success, and the secondary outcomes measured were short-and midterm clinical success (both defined by the Society for Vascular Surgery reporting standards), blood loss, radiation dose, operative time, postoperative endoleaks, aneurysm rupture, endograft patency, and complications. Results We performed 11 F-EVARs during the study period in five (45.5%) males and six (54.5%) females, with a mean age of 75+8 years. All procedures were performed under general anesthesia using OEC 9900 Elite Mobile C-arm (GE Healthcare, Chicago, IL, USA) without the use of fusion technology. Three patients had planned preoperative open procedures for access due to prior cutdown or bypass. Technical success was achieved in all 11 (100%) cases. The mean length of stay was 5+2 days, and the mean follow-up was 7.5+6.5 months. The mean procedure time was 301+167 minutes, and the mean blood loss was 361+233 mL. Mean fluoroscopy time was 72+31 minutes, and the mean radiation exposure time was 2,160+930 mGy. No patients required intraoperative transfusion. Thirty-day (short term) clinical success was achieved in 10 (90.0%), cases whereas six-month (midterm) clinical success was achieved in 7 (77.7%) patients. Branch vessel patency was 11 (100%) at 30 days and 9 (81.8%) at six months, and primary endograft patency was 100% (11) at six months. We had no perioperative mortality or major adverse cardiac event at 30 days. Thirty-day postoperative morbidity included readmission for pulmonary edema from cardiac failure in one patient. Two patients had clinically insignificant silent cardiac enzyme elevation. Three patients had re-interventions performed during the mean follow-up period. Two patients developed renal stent thrombosis resulting in renal insufficiency, which is defined as an increase in creatinine concentration ≥0.5

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Performing Fenestrated Endovascular Abdominal Aneurysm Repair Using a Portable C-arm Without Fusion Technology: A Single-Center Experience

Juneja

Zia

Ayad

et al. 2020

Cureus

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“…Overall, a statistically significant difference was found in fluoroscopy time between the image fusion group and control group for complex EVAR (5 studies) [6][7][8][9][10] ; however, there was no significant difference in standard EVAR (5 studies). 6,17,[19][20][21] In addition, Stangenberg et al 21 was the only study reporting a significant fluoroscopy time reduction during standard EVAR, whereas the other 4 studies reported no difference or even an increase in fluoroscopy time as can be deduced from Table 2. Figure 3A shows the pooled results for the fluoroscopy time in standard EVAR procedures, which was not different after image fusion compared to no image fusion (0 minutes, 95% CI −3.7 to 3.6, p=0.98).…”

Section: Fluoroscopy Timementioning

confidence: 96%

“…Figure 3A shows the pooled results for the fluoroscopy time in standard EVAR procedures, which was not different after image fusion compared to no image fusion (0 minutes, 95% CI −3.7 to 3.6, p=0.98). There was significant heterogeneity (Q=19.9, p=0.001; I 2 =75%) in the 5 included studies 6,17,[19][20][21] and the hospital cohort. The MD of the hospital cohort (0 minutes, 95% CI −7.2 to 6.8, p=0.79) was comparable with the meta-analysis subtotal (0 minutes, 95 CI −4.2 to 4.2, p<0.001) during standard EVAR.…”

Section: Fluoroscopy Timementioning

confidence: 99%

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

et al. 2020

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Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR). Materials and Methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors’ center. Mean differences (MDs) are presented with the 95% confidence interval (CI). Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of −29 mL (95% CI −40.5 to −18.5, p<0.001) and −11 minutes (95% CI −21.0 to −1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD −79 mL, 95% CI −105.7 to −52.4, p<0.001), fluoroscopy time (MD −14 minutes, 95% CI −24.2 to −3.5, p<0.001), and procedure time (MD −52 minutes, 95% CI −75.7 to −27.9, p<0.001). Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR.

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“…Einen Messwert von null kann man nicht optimieren. Zur permanenten und verlässlichen Überwachung der Strahlenbelastung für die Körperbereiche, die von der Röntgenschürze Moderne Röntgenanlagen mit Fusionstechnologie, bei der die computertomografische Angiografie des Patienten mit den intraoperativen Bildern fusioniert wird, können deshalb ebenfalls zur Reduktion der Strahlendosis für Patienten und OP-Personal führen [11,12].…”

Section: Diskussionunclassified

Überwachung der Strahlenexposition im OP mit Echtzeitmessungen: Möglichkeiten und Grenzen

et al. 2020

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Zusammenfassung Hintergrund Die Überwachung von strahlenexponiertem Personal erfolgt in Deutschland mit amtlichen Personendosimetern. Kommerziell erhältliche Echtzeitdosimeter (EZD) lassen sich als Strahlenschutzdosimeter verwenden. Sie werden über der Röntgenschürze getragen und zeigen im Sekundenabstand die aktuell gemessene Ortsdosis an. Diese zeitnahe Einschätzung der Strahlenexposition ermöglicht es dem OP-Personal, durch ein angepasstes Verhalten die eigene Strahlenbelastung während der Eingriffe zu reduzieren. Ziel unserer Arbeit war die Prüfung der Messgenauigkeit der EZD und die Bestimmung der Streustrahlung für einzelne Mitglieder des Operationsteams. Material und Methoden In einem gefäßchirurgischen Operationssaal, ausgestattet mit einem C-Bogen, wurden Messungen der Strahlendosis des OP-Teams mithilfe eines EZD-Systems prospektiv durchgeführt. Zunächst wurde die Kalibrierung der EZD am OP-Tisch mit einem Wasserphantom überprüft. Danach wurden Messungen während gefäßchirurgischer Operationen durchgeführt. Ergebnisse Die Messwerte der einzelnen EZD zeigten bei der Kalibrierung deutliche Abweichungen untereinander, deshalb wurde für jedes EZD ein Korrekturfaktor errechnet. Es wurden insgesamt 55 Eingriffe bei 53 Patienten untersucht. Die durchschnittliche Dosis für den EZD-Operateur bei der EVAR (endovascular aortic repair, n = 11) betrug 9 ± 9 µSv (Bereich 3,6 – 50 µSv) und bei der TEVAR (thoracic EVAR, n = 6) 35 ± 49 µSv (3,8 – 190,3 µSv). Bei den perkutanen transluminalen Angioplastien (PTA) der Beckengefäße und der unteren Extremitäten (n = 20) lag die durchschnittliche Dosis für den EZD-Operateur bei 7 ± 7 µSv (1,2 – 35 µSv) und bei den Angiografien der unteren Extremitäten (n = 12) bei 2 ± 3 µSv (0,2 – 15,9 µSv). Die Echtzeitdosimetrie lieferte Daten, die beim OP-Team mit zu einem veränderten Verhalten im Operationssaal führte. Schlussfolgerung Da die bei der amtlichen Dosimetrie ermittelten Dosiswerte i. d. R. sehr klein sind, ist eine Optimierung des Verhaltens und damit des Strahlenschutzes mit diesen Dosiswerten nicht möglich. Die mit Strahlenschutzdosimetern ermittelten und in der neuen Strahlenschutzverordnung (StrlSchV) definierten Dosisrichtwerte sind dafür besser geeignet. Ein Vergleich der Messdaten, die mit den EZD ermittelt wurden, ist nur durch eine im Vorfeld vorgenommene Kalibrierung möglich.

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A prospective observational trial of fusion imaging in infrarenal aneurysms

Cited by 40 publications

References 25 publications

Safety and Feasibility of Performing Fenestrated Endovascular Abdominal Aneurysm Repair Using a Portable C-arm Without Fusion Technology: A Single-Center Experience

Safety and Feasibility of Performing Fenestrated Endovascular Abdominal Aneurysm Repair Using a Portable C-arm Without Fusion Technology: A Single-Center Experience

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Überwachung der Strahlenexposition im OP mit Echtzeitmessungen: Möglichkeiten und Grenzen

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