Evaluation of a new imaging software for aortic endograft planning

Objective: The aim of this study was to evaluate a new 3D Workstation workflow (EVAR Assist, Advantage Windows, GE Healthcare, Chalfont, UK) (EA-AW) designed to simplify complex EVAR planning. Patients and methods: All pre-operative computed tomography (CT) scans of patients who underwent repair at our institution of a complex aortic aneurysm using fenestrated endovascular repair (f-EVAR) between January and September 2014, were reviewed. For each patient, imaging analysis (12 measures: aortic diameters and length and "clock position" of visceral artery) was performed on two different workstations: Aquarius (TeraRecon, San Mateo, CA, USA) and EA-AW. According to a standardized protocol, three endovascular surgeons experienced in aortic endograft planning, performed image analyses and data collection independently. We analyzed an internal assessment between observers (on the Aquarius 3DWS) and an external assessment comparing these results with the planning center (PC) data used to custom the fenestrated endografts of the patients enrolled in this study. Finally, we compared both 3DWS data to determine the accuracy and the reproducibility. A p-value < .05 was considered as statistically significant. Complete agreement between operators was defined as 1.0. Results: Intra and inter observer variability (interclass correlation coefficients - ICC: 0.81- .091) was very low and confirmed the reliability of our planners. The ICC comparison between EA-AW and Aquarius was excellent (> 0.8 for both), thus confirming the reproducibility and reliability of the new EA-AW application. Aortic and iliac necks diameters and lengths were similarly reported with both workstations. In our study, the mean difference in distance and orientation evaluation of target vessels evaluated by the two workstations was marginal and has no impact on clinical practice in term of device manufacturing. Conclusions: We showed that complex EVAR planning can be performed with this new dedicated 3D workstation workflow with a good reproducibility

Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

info:eu-repo/semantics/publishedVersio

Centerline is not as accurate as outer curvature length to estimate thoracic endograft length.

International audienceBACKGROUND: To assess the accuracy of the aortic outer curvature length for thoracic endograft planning. METHODS: Seventy-four patients (58 men, 66.4 ± 14 years) who underwent thoracic endovascular aortic repair between 2009 and 2011 treated with a Cook Medical endograft were enrolled in this retrospective study. Immediate postoperative CT scans were analysed using EndoSize software. Three vessel lengths were computed between two fixed landmarks placed at each end of the endograft: the straightline (axial) length, the centerline length and the outer curvature length. A tortuosity index was defined as the ratio of the centerline length/straightline length. A Student t test and a Pearson correlation coefficient were used to examine the results. RESULTS: We found a significant difference between the centerline length (135.4 ± 24 mm) and that of the endograft (160 ± 29 mm) (p < .0001). This difference correlates with the tortuosity index (r = .818, p < .0001), the endograft length (r = .587, p < .0001), and the diameter of the endograft (r = .53, p < .0001). However, the outer curvature length (161.3 ± 29 mm) and the endograft length (160 ± 29 mm) were similar (p = .792). CONCLUSION: The outer curvature length more accurately reflects that of the deployed endograft and may prove more accurate than centerlines in planning thoracic endografts

Radiation Dose Reduction During EVAR: Results from a Prospective Multicentre Study (The REVAR Study).

OBJECTIVE To evaluate radiation exposure in standard endovascular aneurysm repair (EVAR) using intra-operative guidance with pre-operative computed tomographic angiography (CTA) fusion and strict ALARA guidelines in a modern hybrid room. MATERIAL AND METHODS Between February and November 2016, consecutive patients with AAA undergoing EVAR with a bifurcated device in a hybrid room under fusion imaging guidance were prospectively enrolled in six aortic centres from the United States (n = 1), Europe (n = 4), and Japan (n = 1). Demographic data including body mass index (BMI), indirect dose area product (DAP), cumulative air kerma (CAK), variables influencing dose delivery, and contrast media volume were collected. RESULTS 85 patients (90.4% males) were included. The median age was 75 (IQR 69-81), with a median BMI of 27.4 (IQR 24.7-30.6). Median DAP and CAK were 14.7 (IQR 10.0-27.7) Gy·cm and 107 (IQR 68.0-189.0) mGy, respectively. The median contrast volume was 47 mL (IQR 35-70) (equivalent to 14.1g of iodine [IQR 10.5-21.0]). Median DAP per centre was 28.1 (n = 16, IQR 12.6-47.1), 15.9 (n = 11, IQR 11.9-22.5), 14.2 (n = 12, IQR 10.9-25.7), 20.2 (n = 18, IQR 7.0-39.5), 10.3 (n = 27, IQR 8.2-14.7) and 26.5 (n = 1) Gy·cm. In multivariable analysis, collimation was the only factor that was significantly associated with DAP reduction, (coefficient = -0.014 per percentage of collimation, 95% CI -0.019 to -0.008, p < .001). CONCLUSIONS With adherence to the ALARA principle and routine application of fusion imaging guidance for EVAR, low radiation exposure compared with the published literature can be achieved in a real world setting

Aortic Rupture During a Staged Endovascular Repair of a Thoracoabdominal Aneurysm

: Introduction: The management and outcome of a patient with a type III thoracoabdominal aortic aneurysm (TAAA) are reported. Methods: The patient was scheduled for a two-stage endovascular repair strategy but experienced a contained TAAA rupture a week before the planned second stage fenestrated endovascular repair that had been postponed from 6 weeks to 5 months. Results: Fortunately, the fenestrated device had already been delivered to the hospital; the contained rupture was thus managed endovascularly in this high-risk patient. Conclusion: Staging extensive TAAA repairs to reduce the incidence of spinal cord ischemia is associated with a risk of interval aneurysm rupture. Keywords: Endovascular TAAA repair, Stage procedure, Paraplegia, Ruptur

Endograft Repair of Complicated Acute Type B Aortic Dissections

Objectives: This study aims to assess patient outcomes and aortic remodelling following coverage of the proximal entry tear with an endograft in complicated acute type B aortic dissections (caTBADs). Material and methods: All patients with caTBAD treated with a thoracic endograft in three high-volume vascular centres were retrospectively studied. Inclusion criteria were branch-vessel malperfusion, impending or overt aortic rupture, maximal aortic diameter >= 40 mm and persistent pain or uncontrolled hypertension despite maximum pharmacological treatment. Postoperative aortic remodelling was evaluated using computed tomography angiography (CTA). on a three-dimensional (3D) imaging workstation. Results: A total of 52 patients (71% male, median age 65 years) were included in the study. Median inclusion criteria per patient were 2 (range 1-4). Branch-vessel malperfusion was diagnosed in 42% and impending aortic rupture in 33% of 52 patients. Median follow-up was 25 months (range 2-109 months). The 30-day mortality rate was 9.6% (5/52); patient survival according to the Kaplan-Meier method was 90.4% at 12 months and 87.6% at 24 months. Secondary interventions were performed in seven patients a median of 3 days after the initial procedure (range 2-865). Imaging follow-up at 12 months was performed in 36 patients (69%): 75% presented stable or shrinking (>5 mm) maximal aortic diameters and 86% had a completely thrombosed false lumen (vs. 5% before initial procedure) at thoracic level. Conclusion: Endograft treatment of complicated caTBAD is associated with favourable early outcomes and possibly promotes aortic remodelling in the majority of patients. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Endovascular management of complex aortic aneurysms

Since the rst endovascular repair of an infrarenal abdominal aortic aneurysm (AAA) published by Parodi et al.,1 stent gras have undergone continuous improvement. Devices have evolved to highly complex, customdesigned devices incorporating branches and fenestrations. ese developments provide an endovascular solution for complex aortic aneurysms (CAAs) incorporating the visceral branches, iliac arteries and supra-aortic trunks (SAT), expanding the indications of EVAR