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Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair.
J Vasc Surg. 2019 Apr; 69(4):1045-1058.e3.JV

Abstract

OBJECTIVE

The objective of this study was to analyze the impact of advanced imaging applications and cone beam computed tomography (CBCT) on radiation exposure of the patient and operator and detection of technical problems during fenestrated-branched endovascular aortic repair (F-BEVAR) for treatment of pararenal aneurysms and thoracoabdominal aortic aneurysms (TAAAs).

METHODS

We reviewed the clinical data of 386 consecutives patients (289 male; mean age, 75 ± 8 years) treated by F-BEVAR for 196 pararenal aneurysms and 190 TAAAs (mean, 3.4 ± 0.9 targeted vessels/patient) between 2007 and 2017. Radiation exposure (cumulative air kerma) was analyzed in three fixed imaging systems used between 2007 and 2011 (system 1), 2012 and 2016 (system 2), and 2016 and 2017 (system 3). Onlay fusion and CBCT were available with systems 2 and 3, whereas digital zoom with fusion overlay was used with system 3. Operator effective dose was measured per month using a radiation dosimeter badge. Computed tomography angiography and CBCT were analyzed for findings requiring immediate revision or secondary interventions. End points were patient radiation exposure; operator effective dose; procedure technical success; and 30-day rates of mortality, major adverse events, and secondary interventions.

RESULTS

F-BEVAR was performed using system 1 in 98 patients, system 2 in 198 patients, and system 3 in 90 patients. Use of onlay fusion/CBCT was 0% with system 1, 42% with system 2, and 98% with system 3. Procedures performed with onlay fusion/CBCT had significantly (P < .05) higher technical success (99.4% vs 98.8%) and lower contrast material volume (155 ± 58 mL vs 172 ± 80 mL), fluoroscopy time (83 ± 34 minutes vs 94 ± 49 minutes), and cumulative air kerma (2561 ± 1920 mGy vs 3767 ± 2307 mGy). Despite higher case volume and increasing complexity during the experience, operator effective dose decreased to 9 ± 4 × 10-2 mSv/case with system 3 compared with 26 ± 3 × 10-2 mSv/case with system 1 and 20 ± 2 × 10-2 mSv/case with system 2 (P = .001). Among 219 patients who had no CBCT, 18 (8%) had computed tomography angiography findings that prompted secondary interventions before dismissal. Conversely, among 167 patients who had CBCT, 14 patients (8%) had intraoperative CBCT findings requiring immediate revision, with no additional secondary interventions. Patients treated with onlay fusion/CBCT had significantly (P < .05) lower mortality (4% vs 1%), major adverse events (43% vs 19%), and secondary interventions (10% vs 4%) at 30 days.

CONCLUSIONS

Radiation exposure and operator effective dose significantly decreased with evolution of F-BEVAR experience and use of advanced imaging applications such as onlay fusion and CBCT. CBCT allowed immediate assessment and identified intraoperative technical problems, leading to immediate revision and avoiding early secondary interventions.

Authors+Show Affiliations

Mayo Clinic Aortic Center and Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.Mayo Clinic Aortic Center and Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: oderich.gustavo@mayo.edu.Mayo Clinic Aortic Center and Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.GE Healthcare, Dearborn, Mich.Mayo Clinic Aortic Center and Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.Department of Radiology, Mayo Clinic, Rochester, Minn.Department of Radiology, Mayo Clinic, Rochester, Minn.Department of Health Science, Mayo Clinic, Rochester, Minn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30527938

Citation

Tenorio, Emanuel R., et al. "Impact of Onlay Fusion and Cone Beam Computed Tomography On Radiation Exposure and Technical Assessment of Fenestrated-branched Endovascular Aortic Repair." Journal of Vascular Surgery, vol. 69, no. 4, 2019, pp. 1045-1058.e3.
Tenorio ER, Oderich GS, Sandri GA, et al. Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair. J Vasc Surg. 2019;69(4):1045-1058.e3.
Tenorio, E. R., Oderich, G. S., Sandri, G. A., Ozbek, P., Kärkkäinen, J. M., Macedo, T. A., Vrtiska, T., & Cha, S. (2019). Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair. Journal of Vascular Surgery, 69(4), 1045-e3. https://doi.org/10.1016/j.jvs.2018.07.040
Tenorio ER, et al. Impact of Onlay Fusion and Cone Beam Computed Tomography On Radiation Exposure and Technical Assessment of Fenestrated-branched Endovascular Aortic Repair. J Vasc Surg. 2019;69(4):1045-1058.e3. PubMed PMID: 30527938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair. AU - Tenorio,Emanuel R, AU - Oderich,Gustavo S, AU - Sandri,Giuliano A, AU - Ozbek,Pinar, AU - Kärkkäinen,Jussi M, AU - Macedo,Thanila A, AU - Vrtiska,Terri, AU - Cha,Stephen, Y1 - 2018/12/04/ PY - 2018/04/20/received PY - 2018/07/09/accepted PY - 2018/12/12/pubmed PY - 2019/11/19/medline PY - 2018/12/12/entrez KW - Cone beam computer tomography (CBCT) KW - Fenestrated-branched endovascular repair (F-BEVAR) KW - Radiation exposure SP - 1045 EP - 1058.e3 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 69 IS - 4 N2 - OBJECTIVE: The objective of this study was to analyze the impact of advanced imaging applications and cone beam computed tomography (CBCT) on radiation exposure of the patient and operator and detection of technical problems during fenestrated-branched endovascular aortic repair (F-BEVAR) for treatment of pararenal aneurysms and thoracoabdominal aortic aneurysms (TAAAs). METHODS: We reviewed the clinical data of 386 consecutives patients (289 male; mean age, 75 ± 8 years) treated by F-BEVAR for 196 pararenal aneurysms and 190 TAAAs (mean, 3.4 ± 0.9 targeted vessels/patient) between 2007 and 2017. Radiation exposure (cumulative air kerma) was analyzed in three fixed imaging systems used between 2007 and 2011 (system 1), 2012 and 2016 (system 2), and 2016 and 2017 (system 3). Onlay fusion and CBCT were available with systems 2 and 3, whereas digital zoom with fusion overlay was used with system 3. Operator effective dose was measured per month using a radiation dosimeter badge. Computed tomography angiography and CBCT were analyzed for findings requiring immediate revision or secondary interventions. End points were patient radiation exposure; operator effective dose; procedure technical success; and 30-day rates of mortality, major adverse events, and secondary interventions. RESULTS: F-BEVAR was performed using system 1 in 98 patients, system 2 in 198 patients, and system 3 in 90 patients. Use of onlay fusion/CBCT was 0% with system 1, 42% with system 2, and 98% with system 3. Procedures performed with onlay fusion/CBCT had significantly (P < .05) higher technical success (99.4% vs 98.8%) and lower contrast material volume (155 ± 58 mL vs 172 ± 80 mL), fluoroscopy time (83 ± 34 minutes vs 94 ± 49 minutes), and cumulative air kerma (2561 ± 1920 mGy vs 3767 ± 2307 mGy). Despite higher case volume and increasing complexity during the experience, operator effective dose decreased to 9 ± 4 × 10-2 mSv/case with system 3 compared with 26 ± 3 × 10-2 mSv/case with system 1 and 20 ± 2 × 10-2 mSv/case with system 2 (P = .001). Among 219 patients who had no CBCT, 18 (8%) had computed tomography angiography findings that prompted secondary interventions before dismissal. Conversely, among 167 patients who had CBCT, 14 patients (8%) had intraoperative CBCT findings requiring immediate revision, with no additional secondary interventions. Patients treated with onlay fusion/CBCT had significantly (P < .05) lower mortality (4% vs 1%), major adverse events (43% vs 19%), and secondary interventions (10% vs 4%) at 30 days. CONCLUSIONS: Radiation exposure and operator effective dose significantly decreased with evolution of F-BEVAR experience and use of advanced imaging applications such as onlay fusion and CBCT. CBCT allowed immediate assessment and identified intraoperative technical problems, leading to immediate revision and avoiding early secondary interventions. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30527938/Impact_of_onlay_fusion_and_cone_beam_computed_tomography_on_radiation_exposure_and_technical_assessment_of_fenestrated_branched_endovascular_aortic_repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)31991-8 DB - PRIME DP - Unbound Medicine ER -