Imaging equipment and techniques for optimal intraoperative imaging during endovascular interventions.

Because endovascular procedures represent an ever-increasing portion of many vascular surgery practices, many surgeons are faced with difficult choices. Endovascular procedures often require open surgery, and open surgical techniques increasingly require fluoroscopic imaging. Without good intraoperative imaging, endovascular procedures are difficult and endovascular aneurysm repair is impossible. How does one balance the need for optimal imaging without sacrificing the ability to safely perform open surgical procedures, especially in the early stages of a developing endovascular program? Strategies include the use of a portable c-arm and carbon fiber table in the operating room (OR), adding a fixed imaging platform to an OR, gaining access to an angiography suite that does not meet OR requirements, and modifying it into an interventional suite that does meet operating room standards. Once the optimal equipment and facilities have been chosen, other choices must be considered. Should a radiology technician be hired? Should an interventional radiologist be available to assist or be incorporated as a routine member of the team? How will typical operating room procedures and technique need to be altered in an effort to optimize intraoperative imaging for endovascular procedures? This article gives an overview of the many issues that arise as a vascular surgery practice evolves to incorporate complex endovascular procedures.