Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin

Abstract

In complex cases of suspected haemorrhage, CBCT images can aid the interventionalist in detecting bleeding sites as well as narrowing down the number of involved vascular territories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1) CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning. (2) CBCT improves visualization of bleeding vessels and involved feeding arteries. (3) Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.

Intra-procedural bronchial artery embolization planning: the usefulness of cone-beam CT

“…Our study population included patients with recurrent mild hemoptysis and without detectable dilated tortuous BAs in available preprocedural CT. This refers to the interdisciplinary long-term experiences with patients suffering from hemoptysis at our institution and the absence of both guidelines as well as metaanalyses on the ideal treatment of these patients (14). However, our results must be evaluated in this clinical context, as the visibility of BAs with aortography and CT may be higher in a patient cohort restricted to cases with massive hemoptysis.…”

“…Initially, a 4-Fr pigtail catheter was used for aortography (3 frames/s; pigtail located in the thoracic aorta) with 60% diluted contrast medium (Ultravist 370; Bayer Schering, Leverkusen, Germany), a flow rate of 15 mL/s and a total amount of 40 mL. Thereafter, CBCT images were acquired under breath-hold after the administration of 50% diluted contrast medium (Ultravist 370, flow rate: 10 mL/s for 8s) with a rotation time of 6 s with the detector moving at 60 /s (14). Acquired CBCT data were sent to a commercially available workstation (syngo XWP, Siemens Healthineers) where CT-like axial images with an isotropic voxel size of 0.5 mm were automatically reconstructed.…”

Cone-Beam CT-assisted navigation for endovascular treatment of erection-related artery stenosis in patients with erectile dysfunction

“…C-arm Cone-Beam computed tomography is integrated in many modern angiographic systems and allows crosssectional imaging and the possibility to use dedicated planning and navigation software (Floridi et al, 2014). Established clinical applications for CBCT and vessel navigation software are embolization therapies for tumors, arterial bleedings (Grosse et al, 2018;Tacher et al, 2015), and revascularization of pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (Sugiyama et al, 2014). In our case, we applied current imaging and navigation techniques to evaluate the vascular anatomy and create a 3D roadmap to reduce time to target lesion and to increase interventional safety.…”

Endovascular Rescue for Renal Artery Pseudoaneurysms following Minimally Invasive Robot-Assisted Partial Nephrectomy—A Case Series

“…Additionally, review of preoperative CT angiogram and use of intraoperative cone beam CT can help in identifying bleeding sites and can help in isolating the involved segments. 12 With a wide variety of embolic agents available currently, preferred agent for management of different types of hemorrhage is indicated in ►Table 2. 13,14 Endoluminal stent-graft (covered stent) can be used to isolate the pseudoaneurysm and percutaneous USG-guided thrombin/ NBCA injection can be attempted in a failed endovascular rescue.…”

“…Additionally, review of preoperative CT angiogram and use of intraoperative cone beam CT can help in identifying bleeding sites and can help in isolating the involved segments. 12…”