UOC di Chirurgia Vascolare, Polo CardioVascolare e Toracico, Fondazione Universitaria Policlinico A. Gemelli, Roma, Italy.
Eur Rev Med Pharmacol Sci. 2017 Jun;21(11):2717-2724.
The aim of this study was to evaluate a new 3D Workstation workflow (EVAR Assist, Advantage Windows, GE Healthcare, Chalfont, UK) (EA-AW) designed to simplify complex EVAR planning.
All pre-operative computed tomography (CT) scans of patients who underwent repair at our institution of a complex aortic aneurysm using fenestrated endovascular repair (f-EVAR) between January and September 2014, were reviewed. For each patient, imaging analysis (12 measures: aortic diameters and length and "clock position" of visceral artery) was performed on two different workstations: Aquarius (TeraRecon, San Mateo, CA, USA) and EA-AW. According to a standardized protocol, three endovascular surgeons experienced in aortic endograft planning, performed image analyses and data collection independently. We analyzed an internal assessment between observers (on the Aquarius 3DWS) and an external assessment comparing these results with the planning center (PC) data used to custom the fenestrated endograft of the patients enrolled in this study. Finally, we compared both 3DWS data to determine the accuracy and the reproducibility. A p-value < .05 was considered as statistically significant. Complete agreement between operators was defined as 1.0.
Intra- and inter-observer variability (interclass correlation coefficients - ICC: 0.81-.091) was very low and confirmed the reliability of our planners. The ICC comparison between EA-AW and Aquarius was excellent (> 0.8 for both), thus confirming the reproducibility and reliability of the new EA-AW application. Aortic and iliac necks diameters and lengths were similarly reported with both workstations. In our study, the mean difference in distance and orientation evaluation of target vessels evaluated by the two workstations was marginal and has no impact on clinical practice in term of device manufacturing.
We showed that complex EVAR planning can be performed with this new dedicated 3D workstation workflow with a good reproducibility.
本研究旨在评估一种新的 3D 工作站工作流程（EVAR Assist，Advantage Windows，GE Healthcare，Chalfont，英国）（EA-AW），旨在简化复杂的 EVAR 规划。
回顾了 2014 年 1 月至 9 月期间在我院接受复杂主动脉瘤修复的患者的所有术前计算机断层扫描（CT）扫描。对于每位患者，在两个不同的工作站上进行成像分析（12 个测量值：主动脉直径和长度以及内脏动脉的“时钟位置”）：Aquarius（TeraRecon，San Mateo，CA，美国）和 EA-AW。根据标准化协议，三位经验丰富的主动脉腔内移植物规划外科医生独立进行图像分析和数据采集。我们分析了观察者之间的内部评估（在 Aquarius 3DWS 上）和将这些结果与用于定制本研究中患者的开窗式血管内移植物的规划中心（PC）数据进行的外部评估。最后，我们比较了这两个 3DWS 数据，以确定准确性和可重复性。p 值<.05 被认为具有统计学意义。操作者之间的完全一致性定义为 1.0。
观察者内和观察者间变异性（组内相关系数 - ICC：0.81-0.091）非常低，证实了我们规划师的可靠性。EA-AW 和 Aquarius 之间的 ICC 比较均非常出色（均>0.8），从而证实了新的 EA-AW 应用的可重复性和可靠性。两个工作站都同样报告了主动脉和髂内颈部的直径和长度。在我们的研究中，两个工作站评估的目标血管的距离和方向评估的平均差异是边缘的，并且在设备制造方面对临床实践没有影响。
我们表明，这种新的专用 3D 工作站工作流程可用于复杂的 EVAR 规划，具有良好的可重复性。
