Service de Chirurgie Vasculaire, Hôpital cardiologique, CHRU Lille, France.
Service d'Imagerie Cardio-Vasculaire et Thoracique, Hôpital Calmette, CHRU de Lille, France.
Eur J Vasc Endovasc Surg. 2015 May;49(5):541-8. doi: 10.1016/j.ejvs.2015.01.010. Epub 2015 Mar 7.
This study evaluated a new strategy to assess technical success after standard and complex endovascular aortic repair (EVAR), combining completion contrast enhanced cone beam computed tomography (ceCBCT) and post-operative contrast enhanced ultrasound (CEUS).
Patients treated with bifurcated or fenestrated and branched endografts in the hybrid room during the study period were included. From December 2012 to July 2013, a completion angiogram (CA) was performed at the end of the procedure, and computed tomography angiography (CTA) before discharge (group 1). From October 2013 to April 2014, a completion ceCBCT was performed, followed by CEUS during the 30 day post-operative period (group 2). The rate of peri-operative events (type I or III endoleaks, kinks, occlusion of target vessels), need for additional procedures or early secondary procedures, total radiation exposure (mSv), and total volume of contrast medium injected were compared.
Seventy-nine patients were included in group 1 and 54 in group 2. Peri-operative event rates were respectively 8.9% (n = 7) and 33.3% (n = 18) (p = .001). Additional procedures were performed in seven patients (8.9%) in group 1 versus 17 (31.5%) in group 2 (p = .001). Two early secondary procedures were performed in group 2 (3.7%), and three (3.8%) in group 1 (p = .978). Median radiation exposure due to CBCT was 7 Gy cm(2) (5.25-8) (36%, 27%, and 9% of the total procedure exposure, respectively for bifurcated, fenestrated, and branched endografts). CEUS did not diagnose endoleaks or any adverse events not diagnosed by ceCBCT. Overall radiation and volume of contrast injected during the patient hospital stay in groups 1 and 2 were 34 (25.8-47.3) and 11 (5-20.5) mSv, and 184 (150-240) and 91 (70-132.8) mL respectively (reduction of 68% and 50%, p < .001).
Completion ceCBCT is achievable in routine practice to assess technical success after EVAR. Strategies to evaluate technical success combining ceCBCT and CEUS can reduce total in hospital radiation exposure and contrast medium volume injection.
本研究评估了一种新策略，即在标准和复杂的血管内主动脉修复术（EVAR）后，结合完成对比增强锥形束 CT（ceCBCT）和术后对比增强超声（CEUS）来评估技术成功。
在研究期间，在杂交手术室中接受分叉或开窗和分支内支架的患者被纳入研究。2012 年 12 月至 2013 年 7 月，在手术结束时进行了完成血管造影术（CA），在出院前进行了计算机断层血管造影术（CTA）（第 1 组）。2013 年 10 月至 2014 年 4 月，进行了完成 ceCBCT，并在术后 30 天内进行了 CEUS（第 2 组）。比较了围手术期事件（I 型或 III 型内漏、扭结、靶血管闭塞）的发生率、需要额外的手术或早期二次手术、总辐射暴露（mSv）和注射的总造影剂体积。
第 1 组有 79 例患者，第 2 组有 54 例患者。围手术期事件发生率分别为 8.9%（n=7）和 33.3%（n=18）（p=0.001）。第 1 组中有 7 例（8.9%）进行了额外的手术，第 2 组中有 17 例（31.5%）（p=0.001）。第 2 组中有 2 例（3.7%）进行了早期的二次手术，第 1 组中有 3 例（3.8%）（p=0.978）。由于 CBCT 导致的中位辐射暴露为 7 Gy cm²（5.25-8）（分别为分叉、开窗和分支内支架总手术暴露的 36%、27%和 9%）。CEUS 没有诊断出 ceCBCT 未诊断的内漏或任何不良事件。第 1 组和第 2 组患者住院期间的总辐射和造影剂注射量分别为 34（25.8-47.3）和 11（5-20.5）mSv，184（150-240）和 91（70-132.8）mL（分别减少 68%和 50%，p<0.001）。
在常规实践中，完成 ceCBCT 可用于评估 EVAR 后的技术成功。结合 ceCBCT 和 CEUS 评估技术成功的策略可以降低总住院辐射暴露和造影剂注射量。
