Christof Johannes Schulz1, Matthias Schmitt1, Dittmar Böckler2, Philipp Geisbüsch1. 1. Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany. 2. Department of Vascular and Endovascular Surgery at the University Hospital Heidelberg, Heidelberg, Germany. Electronic address: dittmar.boeckler@med.uni-heidelberg.de.
Abstract
BACKGROUND: The aim of the study was to analyze the use of contrast-enhanced cone beam computed tomography (ceCBCT) during endovascular aneurysm repair (EVAR) and to compare this imaging modality with standard completion digital subtraction angiography (cDSA) and postoperative computed tomography angiography (CTA) regarding the detection of endograft-associated complications. METHODS: Between September 2012 and April 2015, ceCBCT was used in 98 EVAR patients in addition to cDSA and CTA. Endoleaks, intraluminal thrombus and limb stenoses, contrast agent use, and radiation exposure were recorded for all modalities. RESULTS: cDSA detected 16 (16.3%) endoleaks; ceCBCT, 35 (35.7%) endoleaks; and CTA, 22 (22.4%) endoleaks. All endoleaks identified by cDSA or CTA were also seen on ceCBCT. ceCBCT detected intraluminal thrombus in three patients (none in cDSA or CTA) and previously undetected limb stenoses in three patients. It prompted intraoperative interventions in 7 of 98 patients (7.1%). Replacing cDSA and CTA by ceCBCT would have caused a 39% reduction of in-hospital contrast agent volume in this cohort. CONCLUSIONS: ceCBCT can reliably detect all endograft-associated complications during EVAR. It offers the chance for immediate revision of remediable problems in a relevant proportion of patients and could thus reduce early reintervention rates. ceCBCT can safely replace early follow-up CTA and thereby reduce in-hospital use of contrast media.
BACKGROUND: The aim of the study was to analyze the use of contrast-enhanced cone beam computed tomography (ceCBCT) during endovascular aneurysm repair (EVAR) and to compare this imaging modality with standard completion digital subtraction angiography (cDSA) and postoperative computed tomography angiography (CTA) regarding the detection of endograft-associated complications. METHODS: Between September 2012 and April 2015, ceCBCT was used in 98 EVAR patients in addition to cDSA and CTA. Endoleaks, intraluminal thrombus and limb stenoses, contrast agent use, and radiation exposure were recorded for all modalities. RESULTS:cDSA detected 16 (16.3%) endoleaks; ceCBCT, 35 (35.7%) endoleaks; and CTA, 22 (22.4%) endoleaks. All endoleaks identified by cDSA or CTA were also seen on ceCBCT. ceCBCT detected intraluminal thrombus in three patients (none in cDSA or CTA) and previously undetected limb stenoses in three patients. It prompted intraoperative interventions in 7 of 98 patients (7.1%). Replacing cDSA and CTA by ceCBCT would have caused a 39% reduction of in-hospital contrast agent volume in this cohort. CONCLUSIONS:ceCBCT can reliably detect all endograft-associated complications during EVAR. It offers the chance for immediate revision of remediable problems in a relevant proportion of patients and could thus reduce early reintervention rates. ceCBCT can safely replace early follow-up CTA and thereby reduce in-hospital use of contrast media.
Authors: Aleem K Mirza; Giuliano A Sandri; Emanuel R Tenorio; Jussi M Kärkkäinen; Gustavo S Oderich Journal: J Vasc Surg Cases Innov Tech Date: 2018-08-30