Fusion imaging to support endovascular aneurysm repair using 3D-3D registration
Purpose: To evaluate the feasibility and accuracy of fusion imaging (FI) during endovascular aneurysm repair (EVAR). Methods: FI was performed in 101 consecutive EVAR patients (median age 72 years; 93 men) using automatic registration of the preoperative computed tomography angiography (CTA) with an...
Gespeichert in:
| Hauptverfasser: | , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
25 July 2016
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| In: |
Journal of endovascular therapy
Year: 2016, Jahrgang: 23, Heft: 5, Pages: 791-799 |
| ISSN: | 1545-1550 |
| DOI: | 10.1177/1526602816660327 |
| Online-Zugang: | Verlag, Volltext: http://dx.doi.org/10.1177/1526602816660327 Verlag, Volltext: https://doi.org/10.1177/1526602816660327 
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| Verfasserangaben: | Christof J. Schulz, Matthias Schmitt, Dittmar Böckler, Philipp Geisbüsch |
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| 520 | |a Purpose: To evaluate the feasibility and accuracy of fusion imaging (FI) during endovascular aneurysm repair (EVAR). Methods: FI was performed in 101 consecutive EVAR patients (median age 72 years; 93 men) using automatic registration of the preoperative computed tomography angiography (CTA) with an intraoperative noncontrast cone beam CT (nCBCT; 3D-3D registration). Operative landmarks defined on the CTA were then overlaid in 3 dimensions on fluoroscopy images. Accuracy was measured as the deviation of the position of the lowest renal artery between the FI and angiography. Factors potentially influencing accuracy (α angle, β angle, anesthesia, tortuosity index, neck calcification, neck length, CTA slice thickness, and conventional or sac sealing stent-graft) were analyzed in a multivariate linear regression model. Results: Median procedure time for nCBCT was 3 minutes (range 2-20), with 4 minutes (range 0.4-15) for registration. An automatic registration tool was used successfully in 90 (89%) patients. Median craniocaudal deviation of the FI was 3 mm (range 0-15). Full accuracy (<1-mm deviation) was seen in 23 (23%) patients, 1- to 3-mm deviation in 23 (23%), 4- to 5-mm deviation in 22 (22%), and >5-mm deviation in 33 (33%). Caudal deviation potentially resulting in renal coverage was seen in 9 (9%). Lateral plus craniocaudal deviation was a median 5.8 mm (range 0-22). The position of the lowest renal artery compared to the FI was left and cranial in 62 (61%). Aneurysm morphology (β angle, p=0.04), CTA slice thickness (p=0.02), and the use of 2 stiff guidewires in endovascular aneurysm sealing (p=0.01) influenced the overlay accuracy. Conclusion: Fusion imaging can be integrated into a daily workflow adding little to the procedure time. Craniocaudal accuracy (<5 mm) was achieved in 68% of cases, allowing optimal C-arm and angiographic catheter positioning or cannulation of target vessels in most patients. However, the accuracy of FI does not allow a noncontrast EVAR procedure without confirmation of FI overlay by a minimal contrast injection or vessel cannulation. | ||
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