Koutouzi Giasemi, Henrikson Olof, Roos Håkan, Zachrisson Karin, Falkenberg Mårten
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Endovasc Ther. 2015 Dec;22(6):912-7. doi: 10.1177/1526602815605468. Epub 2015 Sep 17.
To present a new combination of imaging techniques that helps reduce the use of iodinated contrast during endovascular aneurysm repair (EVAR) procedures in patients with renal insufficiency.
Relevant anatomical structures are marked in the preprocedure computed tomography (CT) angiogram. A 3D-3D image fusion between the preprocedure CT and an intraprocedure cone-beam CT is performed in order to overlay anatomical information on live fluoroscopy. Verification of the correct overlay matching (or adjustment if necessary) is based on carbon dioxide (CO2) digital subtraction angiograms (DSA) instead of iodine DSA. The stent-graft is placed and deployed based on the overlaid information. Correct device placement is finally verified with conventional contrast angiography.
The combination of 3D image fusion of a preoperative CT with live fluoroscopy and CO2 DSA verification is feasible and sufficient for guidance of abdominal EVAR. This method minimizes the use of iodinated contrast media, protecting residual function in the setting of preexisting renal insufficiency.
介绍一种新的成像技术组合，有助于减少肾功能不全患者在血管内动脉瘤修复（EVAR）手术期间碘化造影剂的使用。
在术前计算机断层扫描（CT）血管造影中标记相关解剖结构。进行术前CT与术中锥形束CT之间的3D-3D图像融合，以便在实时荧光透视上叠加解剖信息。基于二氧化碳（CO2）数字减影血管造影（DSA）而非碘DSA来验证正确的叠加匹配（或在必要时进行调整）。根据叠加信息放置并展开支架移植物。最终通过传统造影血管造影验证装置的正确放置。
术前CT与实时荧光透视的3D图像融合以及CO2 DSA验证相结合，对于指导腹部EVAR是可行且充分的。该方法可最大限度减少碘化造影剂的使用，在已有肾功能不全的情况下保护残余肾功能。
