New imaging technologies for complex aortic aneurysms diagnosis and treatment

Luis Mariano Ferreira, Antonio Ricardo La Mura, José Álvarez, Patricio Giménez Ruiz, Pablo Diluca, Eduardo Ehyeremendi

Article ID: 1725
Vol 3, Issue 1, 2020

VIEWS - 715 (Abstract) 579 (PDF)

Abstract


Imaging technology plays a key role in guiding endovascular treatment of aortic aneurysm, especially in the complex thoracoabdominal aorta. The combination of high quality images with a sterile and functional environment in the surgical suite can reduce contrast and radiation exposure for both patient and operator, in addition to better outcomes. This presentation aims to describe the current use of this technique, combining angiotomography and intraoperative cone beam computed tomography, image “fusion” and intravascular ultrasound, to guide procedures and thus improve the intraoperative success rate and reduce the need for reoperation. On the other hand, a procedure is described to create customized 3D templates with the high-definition images of the patient’s arterial anatomy, which serve as specific guides for making fenestrated stents in the operating room. These customized fenestration templates could expand the number of patients with complex aneurysms treated minimally invasively.


Keywords


Abdominal Aortic Aneurysm; Endovascular Procedures; Intraoperative Imaging; CBCT; Image Fusion

Full Text:

PDF


References


1. Tenorio ER, Lima GB, Marcondes GB, et al. Sizing and planning fenestrated and branched stent-grafts in patients with chronic post-dissection thoracoabdominal aortic aneurysms. The Journal of Cardiovascular Surgery 2020; 61(4): 416–426. doi: 10.23736/S0021-9509.20.11365-X.

2. Katsargyris A, Uthayakumar V, de Marino P M, et al. Aneurysm rupture and mortality during the waiting time for a customised fenestrated/branched stent graft in complex endovascular aortic repair. European Journal of Vascular and Endovascular Surgery 2020; 60(1): 44–48. doi: 10.1016/j.ejvs.2020.03.003.

3. Duan X, Ananthakrishnan L, Guild JB, et al. Radiation doses and image quality of abdominal CT scans at different patient sizes using spectral detector CT scanner: A phantom and clinical study. Abdominal Radiology 2020; 45(10): 3361–3368. doi: 10.1007/s00261-019-02247-1.

4. Skawran S, Angst F, Blüthgen C, et al. Dual-energy low-keV or single-energy low-kV CT for Endoleak detection? A 6-reader study in an aortic aneurysm phantom. Investigative Radiology 2020; 55(1): 45–52. doi: 10.1097/RLI.0000000000000606.

5. Martin SS, Wichmann JL, Weyer H, et al. Endoleaks after endovascular aortic aneurysm repair: Improved detection with noise-optimized virtual monoenergetic dual-energy CT. European Journal of Radiology 2017; 94: 125–132. doi: 10.1016/j.ejrad.2017.06.017.

6. Meess KM, Izzo RL, Dryjski ML, et al. 3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system. Medical Imaging 2017: Imaging Informatics for Healthcare, Research, and Applications; 2017 Feb 11–16; Orlando, Florida, United States. SPIE; 2017. p. 159–172. doi: 10.1117/12.2253902.

7. Starnes BW. Three-dimensional printed templates to guide fenestrated endovascular aneurysm repair are not as straightforward as they appear. Journal of Vascular Surgery Cases and Innovative Techniques 2020; 6(1): 104–105. doi: 10.1016/j.jvscit.2019.12.002.

8. Gallitto E, Faggioli G, Vacirca A, et al. The benefit of combined carbon dioxide automated angiography and fusion imaging in preserving perioperative renal function in fenestrated endografting. Journal of Vascular Surgery 2020; 72(6): 1906–1916. doi: 10.1016/j.jvs.2020.02.051.

9. Schwein A, Chinnadurai P, Behler G, et al. Computed tomography angiography-fluoroscopy image fusion allows visceral vessel cannulation without angiography during fenestrated endovascular aneurysm repair. Journal of Vascular Surgery 2018; 68(1): 2–11. doi: 10.1016/j.jvs.2017.11.06.

10. Ahmad W, Gawenda M, Brunkwall S, et al. Endovascular Aortoiliac aneurysm repair with fenestrated stent graft and iliac side branch using image fusion without iodinated contrast medium. Annals of Vascular Surgery 2016; 33: 231.e5–231.e9. doi: 10.1016/j.avsg.2015.11.031.

11. Vento V, Soler R, Fabre D, et al. Optimizing imaging and reducing radiation exposure during complex aortic endovascular procedures. The Journal of Cardiovascular Surgery 2018; 60(1): 41–53. doi: 10.23736/S0021- 9509.18.10673-2.

12. Teraa M, Hazenberg C E, Houben I B, et al. Important issues regarding planning and sizing for emergent TEVAR. The Journal of Cardiovascular Surgery 2020; 61(6):708–712. doi: 10.23736/S0021-9509.20.11571-4.

13. Belkin N, Jackson BM, Foley PJ, et al. The use of intravascular ultrasound in the treatment of type B aortic dissection with thoracic endovascular aneurysm repair is associated with improved long-term survival. Journal of Vascular Surgery 2020; 72(2): 490–497. doi: 10.1016/j.jvs.2019.

14. Tenorio ER, Oderich GS, Sandri GA, et al. Prospective nonrandomized study to evaluate cone beam computed tomography for technical assessment of standard and complex endovascular aortic repair. Journal of Vascular Surgery 2020; 71(6): 1982–1993. doi: 10.1016/j.jvs.2019.07.080.

15. Ierardi AM, Pesapane F, Rivolta N, et al. Type 2 endoleaks in endovascular aortic repair: cone beam CT and automatic vessel detection to guide the embolization. Acta Radiologica 2018; 59(6): 681–687. doi: 10.1177/0284185117729184.




DOI: https://doi.org/10.24294/irr.v3i1.1725

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

This site is licensed under a Creative Commons Attribution 4.0 International License.