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

Ann Vasc Surg. 2018 Aug:51:177-186. doi: 10.1016/j.avsg.2018.01.098. Epub 2018 Mar 6.

Abstract

Objective: This study aimed to evaluate the accuracy and the effectiveness of 2D-3D registration method of image fusion (IF) technology in endovascular aneurysm repair (EVAR).

Methods: We performed a review of our institutional endovascular aortic database of patients who had undergone EVAR between 2011 and 2015 before and after the installation of a 3D IF computed tomography system in our hybrid operating room.

Results: The accuracy was assessed in 14 endovascular procedures and showed a median registration error of 1.8 mm at the origin of the right renal artery and 1.0 mm at the origin of the left renal artery and a complete visual accuracy in 42% of the cases. EVAR was performed using the intraoperative IF technique with a 2D-3D registration method in 105 patients (group IF), whereas 47 patients done without served as controls. The IF group had a significantly reduced amount of used contrast compared with controls with a median of 58 mL and P < 0.0001. The intraoperative exposition to radiation was similar between the 2 groups with a median dose area product of 2,343.7 cGy cm2 in the IF group and 3,219 cGy cm2 among the controls (P = 0.457). The radiation dose in the sub group IF (including patients operated by the 2 most experienced surgeons) was lower than that in sub controls (median, 1,087 cG cm2 vs. 2,705.3 cG cm2, P = 0.012). The procedure time and the time of intraoperative radiation did not differ between the study groups (P = 0.117 and 0.106, respectively), as did not fluoroscopy time in the sub group IF (median, 6.3 min, vs. 9.5 min, P = 0.067), but for the 2 most experienced surgeons, the procedural time was shortened when using IF (P = 0.002).

Conclusions: The 2D-3D registration method of IF guidance is accurate to delineate the vessels of interest and could help the execution of the EVAR procedures with a significantly reduced amount of contrast medium and also with reduced radiation and shorter procedural duration when surgeons are more familiar with EVAR and IF.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Aortic Aneurysm / diagnostic imaging*
  • Aortic Aneurysm / surgery*
  • Aortography / adverse effects
  • Aortography / methods*
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Computed Tomography Angiography
  • Contrast Media / administration & dosage*
  • Contrast Media / adverse effects
  • Databases, Factual
  • Endovascular Procedures* / adverse effects
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods*
  • Male
  • Operative Time*
  • Predictive Value of Tests
  • Radiation Dosage
  • Radiation Exposure / adverse effects
  • Radiation Exposure / prevention & control*
  • Radiographic Image Interpretation, Computer-Assisted / methods*
  • Radiography, Interventional* / adverse effects
  • Reproducibility of Results
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome

Substances

  • Contrast Media