The 2D-3D Registration Method in Image Fusion Is Accurate and Helps to Reduce the Used Contrast Medium, Radiation, and Procedural Time in Standard EVAR Procedures

Ahmad, Wael; Obeidi, Youssra; Majd, Payman; Brunkwall, Jan

doi:10.1016/j.avsg.2018.01.098

Cited by 20 publications

(21 citation statements)

References 15 publications

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“…c c e p t e d M a n u s c r i p t can have clinical consequences and must be accounted for, first at the planning step, and then, during the procedure.The fusion error due to aortic deformation estimated in this series is consistent with other recent publications(4,7,8,13,14,17,20,21). Carrel et al(7)have first emphasized the limitations of image fusion in the case of tortuous aortic necks.…”

supporting

confidence: 90%

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

Lalys¹,

Barré²,

Kafi³

et al. 2019

Journal of Vascular and Interventional Radiology

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Purpose. To quantify the displacement of the vascular structures after insertion of stiff devices during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm, and to identify potential parameters influencing this displacement. Materials and Methods. A total of 50 patients from a single center undergoing EVAR were prospectively enrolled between January 2016 and December 2017. Fusion imaging was employed using the EndoNaut® (Therenva, France) station through a 3D/2D technology synchronizing the 3D CT-scan to the live intraoperative fluoroscopy. The accuracy of the fusion road-map was evaluated before deployment by conventional digital subtraction angiogram on a single plane (with different Carm incidences). Results. The mean displacement error of the ostium of the lowest renal artery was 4.1 +/-2.4 mm (range 0-11.7 mm), with a left/right displacement of 1.6 +/-1.7 mm (range 0-6.9 mm) and a craniocaudal displacement of 3.5 +/-2.4 mm (range 0-11.3 mm). The correction required for the ostium of the lower renal artery was mostly cranial and to the left. Multiple linear regression analysis revealed only the sharpest angle between the aneurysm neck and sac as the factor influencing the accuracy of fusion imaging. All other parameters didn't show any correlation. 1 A c c e p t e d M a n u s c r i p t Conclusion. This study identified the sources of fusion error after insertion of rigid material during EVAR. As the sharpest angulation between aneurysm neck and sac increases, the overall accuracy of the fusion might be affected.

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supporting

confidence: 90%

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

Lalys¹,

Barré²,

Kafi³

et al. 2019

Journal of Vascular and Interventional Radiology

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“…Although heterogeneous (Q=30.6, p<0.001; I 2 =80%), the forest plot shows an estimated pooled MD with a significant difference in contrast volume of −29 mL (95% CI −40.5 to −18.5, p<0.001) after image fusion compared with no image fusion. 4,6,[17][18][19]21 The results of the hospital cohort (-6 mL, 95% CI −28.3 to 16.5, p=0.67) are comparable to Hiraoka et al, 18 which had the lowest MD among the meta-analyzed studies (-13 mL, 95% CI −22.1 to −3.50, p=0.009) in standard EVAR.…”

Section: Contrast Volumesupporting

confidence: 68%

“…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: 97%

“…Of the 11 studies selected for analysis ( Figure 1), 7 were retrospective cohort studies [6][7][8]10,17,18,21 and 4 were prospective cohort studies. 4,9,19,20 Preoperative CTA was performed in all studies for fusion guidance except for Stangenberg et al, 21 who performed preoperative MR angiography in one of their 23 patients.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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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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“…The limitations associated with a hybrid OR are scarcely described, but when they are, they tend to focus on aspects such as room space requirements and increased costs during construction. The research focus within the context of hybrid ORs continues to be of medical and technical nature (Ahmad, Obeidi, Majd, & Brunkwall, ; Andres et al, ; Fidalgo Domingos et al, ; McAnelly, Kelleher, Ibrahim, & Antoniou, ; Tsuei et al, ; Ujiie, Effat, & Yasufuku, ). However, the team approach is mentioned as the most critical factor in the success for a hybrid OR (Kaneko & Davidson, ), but to our knowledge, no studies focusing on the team composition or on the staff roles have been conducted.…”

Section: Introductionmentioning

confidence: 99%

Team composition and staff roles in a hybrid operating room: A prospective study using video observations

et al. 2019

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Aim The aim of the study was to evaluate team composition and staff roles in a hybrid operating room during endovascular aortic repairs. Design Quantitative descriptive design. Methods Nine endovascular aortic repairs procedures were video‐recorded between December 2014 and September 2015. The data analysis involved examining the work process, number of people in the room and categories of staff and their involvement in the procedure. Results The procedures were divided into four phases. The hybrid operating room was most crowded in phase 3 when the skin wound was open. Some staff categories were in the room for the entire procedure even if they were not actively involved. The largest number of people simultaneously in the room was 14.

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The 2D-3D Registration Method in Image Fusion Is Accurate and Helps to Reduce the Used Contrast Medium, Radiation, and Procedural Time in Standard EVAR Procedures

Cited by 20 publications

References 15 publications

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

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

Team composition and staff roles in a hybrid operating room: A prospective study using video observations

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