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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2024

Open Access 01-12-2024 | Research

Image fusion guidance for left subclavian artery in situ fenestration during thoracic endovascular repair

Authors: Liang Zhao, Jidong Liu, Xiaoshu Cai, Wengang Yang, Ji Wang

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

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Abstract

Objectives

To evaluate the feasibility and clinical benefit of utilizing image fusion for thoracic endovascular repair (TEVAR) with in situ fenestration (ISF-TEVAR).

Materials and methods

Between January 2020 and December 2020, we prospectively collected 18 consecutive cases with complex thoracic aortic lesions who underwent image fusion guided ISF-TEVAR. As a control group, 18 patients were collected from historical medical records from June 2019 to December 2019. The fusion group involved the use of 3D fusion of CTA and fluoroscopic images for real-time 3D guidance, and the control group involved the use of only regular fluoroscopic images for guidance. The total contrast medium volume, hand-injected contrast medium volume, overall operative time, radiation dose and fluoroscopy time were compared between the two groups. Accuracy was measured based on preoperative CTA and intraoperative digital subtraction angiography.

Results

3D fusion imaging guidance was successfully implemented in all patients in the fusion group. Hand-injected contrast medium volume and overall operative time were significantly lower in the fusion group than in the control group (p = .028 and p = .011). Compared with the control group, the fusion group showed a significant reduction in time and radiation dose-area product (DAP) for fluoroscopy (p = .004 and p = .010). No significant differences in total radiation dose (DAP) or total contrast medium volume were observed (p = .079 and p = .443). Full accuracy was achieved in 8 cases (44%), with a mean deviation of 2.61 mm ± 3.1 (range 0.0-8.4 mm).

Conclusions

3D image fusion for ISF-TEVAR was associated with a significant reduction in hand-injected contrast medium, time and radiation exposure for fluoroscopy and overall operative time. The image fusion guidance showed potential clinical benefits towards improved treatment safety and accuracy for complex thoracic endovascular interventions.
Literature
1.
Grabenwöger M et al. Thoracic endovascular aortic repair (TEVAR) for the treatment of aortic diseases: a position statement from the European association for cardio-thoracic surgery (EACTS) and the European society of cardiology (ESC), in collaboration with the European assoc, in European Journal of Cardio-thoracic surgery. 2012.
2.
Erbel R et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014.
3.
Nauta FJH et al. Update in the management of type B aortic dissection, in Vascular Medicine (United Kingdom). 2016.
4.
Kanaoka Y et al. Technical Challenges in Endovascular Repair of Complex Thoracic Aortic Aneurysms, in Annals of Vascular Diseases. 2012.
5.
Matsumura JS et al. The Society for vascular surgery practice guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. in J Vasc Surg. 2009.
6.
Ohrlander T et al. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. in J Endovasc Ther. 2008.
7.
Mangialardi N et al. Value and limitations of chimney grafts to treat arch lesions. in J Cardiovasc Surg. 2015.
8.
Kanaoka Y et al. Outcomes of Chimney Thoracic Endovascular Aortic Repair for an Aortic Arch Aneurysm, in Annals of Vascular Surgery. 2020.
9.
Katsargyris A et al. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift?, in J Endovasc Ther. 2013.
10.
Taneva GT et al. Cost-effectiveness analysis of chimney/snorkel versus fenestrated endovascular repair for high-risk patients with complex abdominal aortic pathologies. in J Cardiovasc Surg. 2020.
11.
Redlinger RE, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. in J Vasc Surg. 2013.
12.
Malina M, Sonesson B. In situ fenestration: a novel option for endovascular aortic arch repair. in J Cardiovasc Surg. 2015.
13.
Qin J et al. In situ laser fenestration is a feasible method for revascularization of aortic Arch during thoracic endovascular aortic repair. in J Am Heart Association. 2017.
14.
Leung AD, Yamanouchi D. Case report of retrograde in situ fenestration of the thoracic stent graft with reentry device in a patient with aortobronchial fistula, in Medicine (United States). 2018.
15.
Yerram S et al. In-situ fenestration of aortic stent graft in the management of thoracic aortic aneurysm: A case report and review of technique, in IHJ Cardiovascular Case Reports (CVCR). 2020.
16.
Schulz CJ et al. Feasibility and accuracy of fusion imaging during thoracic endovascular aortic repair. in J Vasc Surg. 2016.
17.
Schulz CJ et al. Fusion Imaging to support endovascular aneurysm repair using 3D-3D Registration. in J Endovasc Ther. 2016.
18.
Koutouzi G et al. 3D Image Fusion to Localise Intercostal Arteries During TEVAR, in EJVES Short Reports. 2017.
19.
Barral PA et al. Fusion Imaging to Guide thoracic endovascular aortic repair (TEVAR): a Randomized comparison of two methods, 2D/3D versus 3D/3D image Fusion, in CardioVascular and Interventional Radiology. 2019.
20.
Dijkstra ML et al. Intraoperative C-arm cone-beam computed tomography in fenestrated/branched aortic endografting. in J Vasc Surg. 2011.
21.
Kobeiter H, Nahum J, Becquemin JP. Zero-contrast thoracic endovascular aortic repair using image fusion. Circulation. 2011.
22.
Tacher V et al. Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vascular Interventional Radiol. 2013.
23.
Sailer AM et al. CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair. Eur J Vascular Endovascular Surg. 2014.
24.
Goudeketting SR et al. Pros and cons of 3D image Fusion in Endovascular Aortic Repair: a systematic review and Meta-analysis. in J Endovasc Ther. 2017.
25.
Doelare SAN et al. Image Fusion during Standard and Complex Endovascular Aortic Repair, to fuse or not to fuse? A Meta-analysis and additional data from a single-Center Retrospective Cohort. in J Endovasc Ther. 2021.
26.
Touma J et al. Triple In Situ Antegrade Laser Fenestration of Aortic Stent-Graft Extension Using Fusion Imaging for Urgent Treatment of Symptomatic Abdominal Aneurysm with Type 1 Endoleak, in CardioVascular and Interventional Radiology. 2018.
27.
Leger T et al. Image Fusion Guidance for In Situ Laser Fenestration of Aortic Stent graft for Endovascular Repair of Complex Aortic Aneurysm: Feasibility, Efficacy and Overall Functional Success, in CardioVascular and Interventional Radiology. 2019.
28.
CT B. Guide to Peripheral and Cerebrovascular Intervention. Thoracic aorta and the great vessels, ed. B. DL. 2004, London: Remedica.
29.
Dias NV et al. The effects of combining fusion imaging, low-frequency pulsed fluoroscopy, and low-concentration contrast agent during endovascular aneurysm repair. in J Vasc Surg. 2016.
30.
Hiraoka A et al. Feasibility of three-dimensional fusion imaging with multimodality roadmap system during endovascular aortic repair. in J Vasc Surg. 2018.
Metadata
Title
Image fusion guidance for left subclavian artery in situ fenestration during thoracic endovascular repair
Authors
Liang Zhao
Jidong Liu
Xiaoshu Cai
Wengang Yang
Ji Wang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-024-02561-w

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