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3D Image Fusion to Localise Intercostal Arteries During TEVAR

Artikel i vetenskaplig tidskrift
Författare Giasemi Koutouzi
Charlotte Sandström
P. Skoog
H. Roos
Mårten Falkenberg
Publicerad i EJVES Short Reports
Volym 35
Sidor 7-10
ISSN 2405-6553
Publiceringsår 2017
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för radiologi
Sidor 7-10
Språk en
Länkar https://doi.org/10.1016/j.ejvssr.20...
Ämnesord 3D image fusion, Cone-beam CT, Image guidance, Intercostal artery, Spinal cord ischaemia, TEVAR
Ämneskategorier Radiologi

Sammanfattning

Purpose Preservation of intercostal arteries during thoracic aortic procedures reduces the risk of post-operative paraparesis. The origins of the intercostal arteries are visible on pre-operative computed tomography angiography (CTA), but rarely on intra-operative angiography. The purpose of this report is to suggest an image fusion technique for intra-operative localisation of the intercostal arteries during thoracic endovascular repair (TEVAR). Technique The ostia of the intercostal arteries are identified and manually marked with rings on the pre-operative CTA. The optimal distal landing site in the descending aorta is determined and marked, allowing enough length for an adequate seal and attachment without covering more intercostal arteries than necessary. After 3D/3D fusion of the pre-operative CTA with an intra-operative cone-beam CT (CBCT), the markings are overlaid on the live fluoroscopy screen for guidance. The accuracy of the overlay is confirmed with digital subtraction angiography (DSA) and the overlay is adjusted when needed. Stent graft deployment is guided by the markings. The initial experience of this technique in seven patients is presented. Results 3D image fusion was feasible in all cases. Follow-up CTA after 1 month revealed that all intercostal arteries planned for preservation, were patent. None of the patients developed signs of spinal cord ischaemia. Conclusion 3D image fusion can be used to localise the intercostal arteries during TEVAR. This may preserve some intercostal arteries and reduce the risk of post-operative spinal cord ischaemia. © 2017 The Authors

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