Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures

Stahlberg, Erik; Planert, M.; Panagiotopoulos, Nikolaos; Horn, Marco; Wiedner, Marcus; Kleemann, Markus; Barkhausen, Jörg; Goltz, Jan Peter

doi:10.1016/j.ejvs.2016.10.016

Cited by 15 publications

(4 citation statements)

References 25 publications

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“…Typical projection angles to visualize iliac bifurcations range from 20° to 60° 5 (Table 1), which frequently are geometrically impossible to reach, and even if achieved, it implies a decrease in image quality and increase in the scatter radiation. FORS technology works independently of these geometric restrictions and can display any projection without adding any radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Panuccio¹,

Torrealba²,

Rohlffs³

et al. 2022

J Endovasc Ther

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Purpose: The purpose of this study was to describe the use of a wire and catheters embedded with optical fiber (Fiber Optic RealShape [FORS]) to catheterize tortuous target vessels avoiding radiation. Technique: A virtual biplane vies was simulated coupling traditional x-ray system, preoperative CT scan, and FORS system to treat an isolated hypogastric aneurysm. Despite the complex anatomy, catheterization of all target vessels was possible in 12 minutes with 19 seconds of fluoroscopy time (Radiation Exposure 3.8 mGy×cm2). A minimal invasive endovascular exclusion of the aneurysm was achieved through selective coil-embolization of the iliolumbar artery and implantation of balloon expandable covered stents, thus preserving the perfusion of the superior gluteal artery. Conclusion: FORS guidance allowed catheterization of a target vessel with challenging anatomy with a low radiation exposure.

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Section: Discussionmentioning

confidence: 99%

Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Panuccio¹,

Torrealba²,

Rohlffs³

et al. 2022

J Endovasc Ther

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“…Traditionally, the anatomy of the iliac bifurcation is assessed with roadmaps using 20 to 30 contralateral anterior oblique projection, in order to separate the internal from external iliac artery. 18 Stahlberg et al 19 reported in a recent study that calculation of an appropriate C-arm position based on preoperative CTA can significantly decrease the number of digital subtraction angiograms needed for successful visualization of the iliac bifurcations, thus reducing radiation and contrast dose.…”

Section: Discussionmentioning

confidence: 99%

“…18 Stahlberg et al. 19 reported in a recent study that calculation of an appropriate C-arm position based on preoperative CTA can significantly decrease the number of digital subtraction angiograms needed for successful visualization of the iliac bifurcations, thus reducing radiation and contrast dose.…”

Section: Discussionmentioning

confidence: 99%

Iliac artery deformation during EVAR

et al. 2019

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Objectives To quantify the deformation of the common iliac artery caused by stiff guide wires and delivery systems during abdominal endovascular aortic repair (EVAR). Methods Twenty-two patients treated with abdominal EVAR were included. The following three image data-sets were acquired for each patient: (1) a preoperative computed tomography angiography (CTA), (2) an intraoperative contrast-enhanced cone beam CT (CBCT) obtained after the main trunk of the bifurcated stent graft was released and both iliac limbs were engaged with stiff guide wires, and (3) the first postoperative CTA. These data-sets were merged and compared in an image analysis work station. The length and the tortuosity index of the common iliac artery, the Euclidian displacement of the aortic and the iliac bifurcations, and the optimal C-arm angulation for projection of the iliac bifurcation were computed. Results The common iliac artery was on average 6.4 mm shorter ( p < 0.001) and tortuosity index was lower ( p = 0.003) in the intraoperative images compared to preoperative. Some of the foreshortening was reversed postoperatively, remaining mean length difference was 2.9 mm ( p = 0.007) compared to preoperative. Intraoperatively, the aortic bifurcation was mostly displaced in a cranial direction (100%) and the iliac bifurcation in a ventral direction (93%). The optimal lateral C-arm angulation for projection of the iliac bifurcation changed. Anterior contralateral angle increased from median 42° (IQR, 27–63) in the preoperative CTA to 62 (49–74) in the intraoperative CBCT ( p = 0.02). Optimal cranio-caudal angulation did not change. Conclusion Stiff guide wires and delivery systems cause significant deformation of the common iliac arteries during EVAR. The aortic bifurcation is more cranial, the common iliac arteries are shorter, and optimal C-arm angulation is more contralateral oblique when the iliac limbs are to be deployed compared to baseline measurements from preoperative CTA. This affects image fusion accuracy and stent graft selection.

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“…der supra-und infrarenalen Angulation) exakt beurteilt werden. Ferner lassen sich die geeigneten C-Arm-Angulationen berechnen, die während einer endovaskulären Therapie dazu beitragen können, die Strahlen-und Kontrastmittelexposition zu senken [27].…”

Section: Monatenunclassified

Bauchaortenaneurysma – Diagnostik und interventionell-radiologische Therapie

Anton¹,

Stahlberg²,

Goltz³

2019

Radiopraxis

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Das Bauchaortenaneurysma (BAA) als eine fokale Erweiterung aller Wandschichten der Aorta abdominalis ist ein komplexes und lebensbedrohliches Krankheitsbild – Albert Einstein und Charles de Gaulle sind an einer Ruptur verblutet. Eine endovaskuläre Aortenreparatur (EVAR) oder offen-chirurgische Therapie haben das Ziel, das Rupturrisiko niedrig zu halten bzw. zu eliminieren und die Lebenserwartung des Patienten zu verbessern.

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Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures

Abstract: Pre-operative simulation of the appropriate C-arm angulation in two dimensions using dedicated computed tomography angiography post-processing software is feasible and significantly reduces radiation and contrast medium exposure.

Cited by 15 publications

References 25 publications

Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Iliac artery deformation during EVAR

Bauchaortenaneurysma – Diagnostik und interventionell-radiologische Therapie

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