Standard and fenestrated endograft sizing in EVAR planning: Description and validation of a semi-automated 3D software

Macía, Iván; Blas, Mariano De; Legarreta, Jon Haitz; Kabongo, Luis; Hernández, Óscar Sosa; Egaña, José María; Emparanza, José Ignacio; García-Familiar, Ainhoa; Graña, Manuel

doi:10.1016/j.compmedimag.2015.01.007

Cited by 9 publications

(17 citation statements)

References 20 publications

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“…The aortic lumen appears in the image as a highly contrasted structure with marked borders, due to the injected contrast agent and the presence of the metallic stent. To segment it, the adaptive region growing algorithm proposed in Macía et al (2016) is employed.…”

Section: Methodsmentioning

confidence: 99%

“…In order to obtain the centerline, an initial skeleton is extracted from the segmented lumen via distance-based homotopic thinning. This skeleton is noisy and presents spurious branches and loops that must be removed in order to have a final centerline, which is obtained following the procedure in Macía et al (2016). Since the goal is to use the centerline to compute the straightening of the aorta, only the three largest branches are kept, which correspond to the main aortic centerline and the centerlines in the endograft-limited area, as shown in Figure 2.…”

Section: Methodsmentioning

confidence: 99%

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Image-Based 3D Characterization of Abdominal Aortic Aneurysm Deformation After Endovascular Aneurysm Repair

López-Linares

Garcı́a

García

et al. 2019

Front. Bioeng. Biotechnol.

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An abdominal aortic aneurysm (AAA) is a focal dilation of the abdominal aorta, that if not treated, tends to grow and may rupture. The most common treatment for AAAs is the endovascular aneurysm repair (EVAR), which requires that patients undergo Computed Tomography Angiography (CTA)-based post-operative lifelong surveillance due to the possible appearance of complications. These complications may again lead to AAA dilation and rupture. However, there is a lack of advanced quantitative image-analysis tools to support the clinicians in the follow-up. Currently, the approach is to evaluate AAA diameter changes along time to infer the progress of the patient and the post-operative risk of AAA rupture. An increased AAA diameter is usually associated with a higher rupture risk, but there are some small AAAs that rupture, whereas other larger aneurysms remain stable. This means that the diameter-based rupture risk assessment is not suitable for all the cases, and there is increasing evidence that the biomechanical behavior of the AAA may provide additional valuable information regarding the progression of the disease and the risk of rupture. Hence, we propose a promising methodology for post-operative CTA time-series registration and subsequent aneurysm biomechanical strain analysis. From these strains, quantitative image-based descriptors are extracted using a principal component analysis of the tensile and compressive strain fields. Evaluated on 22 patients, our approach yields a mean area under the curve of 88.6% when correlating the strain-based quantitative descriptors with the long-term patient prognosis. This suggests that the strain information directly extracted from the CTA images is able to capture the biomechanical behavior of the aneurysm without relying on finite element modeling and simulation. Furthermore, the extracted descriptors set the basis for possible future imaging biomarkers that may be used in clinical practice. Apart from the diameter, these biomarkers may be used to assess patient prognosis and to enable informed decision making after an EVAR intervention, especially in difficult uncertain cases.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Image-Based 3D Characterization of Abdominal Aortic Aneurysm Deformation After Endovascular Aneurysm Repair

López-Linares

Garcı́a

García

et al. 2019

Front. Bioeng. Biotechnol.

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“…These measurements, which are typically performed using a central lumen line (CLL) to generate 3-dimensional (3D) reconstructions from computed tomography angiography (CTA) scans of the aorta and branch arteries, have good interobserver agreement for both standard and complex EVAR planning. [6][7][8][9] The Cook Zenith Fenestrated endograft (Cook Medical Inc, Bloomington, IN, USA) was the first commercially available fenestrated design. It consists of self-expanding stainless steel Z-stents covered with full-thickness woven polyester fabric containing fenestrations between the struts of the Z-stents.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

et al. 2020

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Purpose: To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. Materials and Methods: The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. Results: There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Conclusion: Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.

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“…Centerline-based assessment of computed tomography angiography (CTA) is state of the art for planning endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysm (AAA), 1,2 as well as in thoracic endovascular aortic repair (TEVAR). It provides fast and reproducible measurements in both EVAR 3,4 and TEVAR 5,6 despite limited verifiability.…”

Section: Introductionmentioning

confidence: 99%

How Precise Are Preinterventional Measurements Using Centerline Analysis Applications? Objective Ground Truth Evaluation Reveals Software-Specific Centerline Characteristics

et al. 2017

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Standard and fenestrated endograft sizing in EVAR planning: Description and validation of a semi-automated 3D software

Cited by 9 publications

References 20 publications

Image-Based 3D Characterization of Abdominal Aortic Aneurysm Deformation After Endovascular Aneurysm Repair

Image-Based 3D Characterization of Abdominal Aortic Aneurysm Deformation After Endovascular Aneurysm Repair

Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

How Precise Are Preinterventional Measurements Using Centerline Analysis Applications? Objective Ground Truth Evaluation Reveals Software-Specific Centerline Characteristics

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