Clinical StudySource of Errors and Accuracy of a Two-Dimensional/Three-Dimensional Fusion Road Map for Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm
Section snippets
Study Design and Patient Population
This study was compliant with the Health Insurance Portability and Accountability Act and was approved by the institutional review boards of the participating hospitals. All patients signed an informed consent form. The study included 16 subjects (12 men and 4 women) with a mean age of 77 years (range, 66–85 y) undergoing EVAR (between August 2011 and April 2013) in the interventional suite where the AAA interventional guidance tool prototype was installed.
Preoperative Multidetector CT Protocols and Image Segmentation and Registration
The 16 multidetector CT examinations
Technical Success
All main steps of the AAA guidance tool for EVAR workflow were performed successfully for the 16 patients. The mean volume of contrast agent injected and fluoroscopy time were 110 mL and 26.4 minutes for standard EVAR and 156 mL and 176 minutes for FEVAR and branched graft (thoracoabdominal) EVAR (Table 2).
Renal and Bone Displacements
Before correction, the mean absolute misregistration on the lowest renal artery was estimated at x-axis = 10.6 mm ± 11.1/z-axis = 7.4 mm ± 5.3 for R1, x-axis = 10.6 mm ± 11.1/z-axis = 7.5 mm
Discussion
Our study results show that rigid 3D fusion of cone beam CT and CT angiography is feasible and fairly accurate for EVAR guidance. The correction tool based on DSA acquisition improves significantly the misregistration and the SCAV. However, to achieve this correction, a limited contrast agent injection before delivering the stent graft is needed.
Before any correction, the SCAV was low for more than half of the patients owing to a cumulative error combining patient displacement mainly at the
Acknowledgment
This work was supported by a joint grant from the Canadian Institute of Health Research, Object Research System, and Siemens AG Healthcare Sector, Forchheim Germany (CIHR-UI Industry Partnered Collaborative Research, Grant No. ISO-93328). G.S. holds a national scientist award from the Fonds de la Recherche en Santé du Québec.
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2019, Journal of Vascular and Interventional RadiologyCitation Excerpt :The estimation of the fusion error was performed by 2 experts (ICC = 0.98). It was in line with the work of Kauffmann et al. (14), which reported a very high interobserver agreement for the measurements of renal artery displacement (ICC > 0.99). In conclusion, this study tested the influence of anatomic parameters that could have an influence on the vascular displacement usually observed with fusion imaging during aortic endovascular procedures.
M.P. is funded by Siemens Medical.
None of the other authors have identified a conflict of interest.