Thomas Leger1, Vania Tacher1,2,3, Marek Majewski4, Joseph Touma4, Pascal Desgranges2,4, Hicham Kobeiter5,6. 1. Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 2. Université Paris-Est Créteil (UPEC), 94010, Créteil, France. 3. Unité INSERM U955 #18, IMRB, Créteil, France. 4. Assistance Publique - Hôpitaux de Paris (AP-HP), Service de chirurgie vasculaire, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 5. Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. hicham.kobeiter@aphp.fr. 6. Université Paris-Est Créteil (UPEC), 94010, Créteil, France. hicham.kobeiter@aphp.fr.
Abstract
OBJECTIVE: To evaluate feasibility, efficacy and overall functional success of image fusion guidance during laser-assisted in situ fenestration of aortic stent graft (LISFAS) for endovascular repair of complex aortic aneurysm (complex-EVAR) in a prospective study. METHODS: Between September 2016 and July 2018, 20 patients were included and treated with LISFAS for complex-EVAR. Aortic aneurysms were either para-renal (n = 15) or thoraco-abdominal (n = 5) with 57 mm [first quartile: 54; third quartile: 68] median aneurysm diameter in 69 years [68;78] patients. All interventions were performed using the same angiographic system and 3D image fusion software for overlying pre-intervention CTA on per-intervention 2D fluoroscopy with cone-beam CT images to display target vessels ostia. RESULTS: LISFAS for complex-EVAR with image fusion was performed in all patients, and no endovascular intervention required conversion to an open aortic repair. LISFAS of all target vessels was feasible in 18 patients (90%); 48 fenestrations out of 50 were performed successfully. Two fenestrations failed for renal arteries in two patients. Median ischemic times were as follows: 34 min [25;43] for superior mesenteric artery; 69 min [56;83] for left renal artery; 73 min [36;102] for right renal artery; and 93 min [89;96] for the celiac trunk. Median intervention and fluoroscopy times, iodinated contrast volume and X-ray exposure were 180 min [150;180], 74 min [64;87], 80 mL [59;113] and 338 Gy.cm2 [259;495], respectively. Efficacy was found in 17 patients (85%) on one-week follow-up CTA: Two patients had type 1 and 3 endoleaks, respectively, that were successfully embolized. Overall functional success was 90%. Median hospitalization stay was 9 days [8, 17]. The 30-day safety analysis was 90% (n = 2 deaths) owing to an undetermined cause and to bowel ischemia after low flow in intensive care unit. CONCLUSIONS: LISFAS using image fusion was feasible, efficient and overall functionally successful for complex-EVAR in this preliminary study.
OBJECTIVE: To evaluate feasibility, efficacy and overall functional success of image fusion guidance during laser-assisted in situ fenestration of aortic stent graft (LISFAS) for endovascular repair of complex aortic aneurysm (complex-EVAR) in a prospective study. METHODS: Between September 2016 and July 2018, 20 patients were included and treated with LISFAS for complex-EVAR. Aortic aneurysms were either para-renal (n = 15) or thoraco-abdominal (n = 5) with 57 mm [first quartile: 54; third quartile: 68] median aneurysm diameter in 69 years [68;78] patients. All interventions were performed using the same angiographic system and 3D image fusion software for overlying pre-intervention CTA on per-intervention 2D fluoroscopy with cone-beam CT images to display target vessels ostia. RESULTS: LISFAS for complex-EVAR with image fusion was performed in all patients, and no endovascular intervention required conversion to an open aortic repair. LISFAS of all target vessels was feasible in 18 patients (90%); 48 fenestrations out of 50 were performed successfully. Two fenestrations failed for renal arteries in two patients. Median ischemic times were as follows: 34 min [25;43] for superior mesenteric artery; 69 min [56;83] for left renal artery; 73 min [36;102] for right renal artery; and 93 min [89;96] for the celiac trunk. Median intervention and fluoroscopy times, iodinated contrast volume and X-ray exposure were 180 min [150;180], 74 min [64;87], 80 mL [59;113] and 338 Gy.cm2 [259;495], respectively. Efficacy was found in 17 patients (85%) on one-week follow-up CTA: Two patients had type 1 and 3 endoleaks, respectively, that were successfully embolized. Overall functional success was 90%. Median hospitalization stay was 9 days [8, 17]. The 30-day safety analysis was 90% (n = 2 deaths) owing to an undetermined cause and to bowel ischemia after low flow in intensive care unit. CONCLUSIONS: LISFAS using image fusion was feasible, efficient and overall functionally successful for complex-EVAR in this preliminary study.
Entities:
Keywords:
3D image fusion guidance; Complex-AAA; Complex-EVAR; In situ laser fenestration
Authors: Timo C Meine; Cornelia L A Dewald; L S Becker; Aline Mähringer-Kunz; Benjamin Massoumy; Sabine K Maschke; Martha M Kirstein; Thomas Werncke; Frank K Wacker; Bernhard C Meyer; Jan B Hinrichs Journal: Abdom Radiol (NY) Date: 2020-11
Authors: Callum D Little; Eleanor C Mackle; Efthymios Maneas; Debra Chong; Daniil Nikitichev; Jason Constantinou; Janice Tsui; George Hamilton; Roby D Rakhit; Tara M Mastracci; Adrien E Desjardins Journal: Int J Comput Assist Radiol Surg Date: 2022-04-10 Impact factor: 3.421