The 2D 3D Registration Method in Image Fusion Is Accurate and Helps to Reduce the Used Contrast Medium, Radiation, and Procedural Time in Standard EVAR Procedures.
OBJECTIVE This study aimed to evaluate the accuracy and the effectiveness of 2D 3D registration method of image fusion (IF) technology in endovascular aneurysm repair (EVAR) METHODS We performed a review of our institutional endovascular aortic database of patients who had undergone EVAR between 2011 and 2015 before and after the installation of a 3D IF computed tomography system in our hybrid operating room. RESULTS The accuracy was assessed in 14 endovascular procedures and showed a median registration error of 1.8 mm at the origin of the right renal artery and 1.0 mm at the origin of the left renal artery and a complete visual accuracy in 42% of the cases. EVAR was performed using the intraoperative IF technique with a 2D 3D registration method in 105 patients (group IF) whereas 47 patients done without served as controls. The IF group had a significantly reduced amount of used contrast compared with controls with a median of 58 mL and P 0.0001. The intraoperative exposition to radiation was similar between the 2 groups with a median dose area product of 2,343.7 cGy cm2 in the IF group and 3,219 cGy cm2 among the controls (P 0.457) The radiation dose in the sub group IF (including patients operated by the 2 most experienced surgeons) was lower than that in sub controls (median, 1,087 cG cm2 vs. 2,705.3 cG cm2, P 0.012) The procedure time and the time of intraoperative radiation did not differ between the study groups (P 0.117 and 0.106, respectively) as did not fluoroscopy time in the sub group IF (median, 6.3 min, vs. 9.5 min, P 0.067) but for the 2 most experienced surgeons, the procedural time was shortened when using IF (P 0.002) CONCLUSIONS The 2D 3D registration method of IF guidance is accurate to delineate the vessels of interest and could help the execution of the EVAR procedures with a significantly reduced amount of contrast medium and also with reduced radiation and shorter procedural duration when surgeons are more familiar with EVAR and IF.
Annals of vascular surgery