Koutouzi G, Sandström C, Skoog P, Roos H, Falkenberg M
Institute of Clinical Sciences, Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
EJVES Short Rep. 2017 Apr 4;35:7-10. doi: 10.1016/j.ejvssr.2017.03.001. eCollection 2017.
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).
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.
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.
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.
在胸主动脉手术中保留肋间动脉可降低术后截瘫风险。肋间动脉的起源在术前计算机断层血管造影（CTA）上可见，但在术中血管造影中很少见。本报告的目的是提出一种用于在胸主动脉腔内修复术（TEVAR）期间术中定位肋间动脉的图像融合技术。
在术前CTA上识别肋间动脉的开口并用环手动标记。确定并标记降主动脉中的最佳远端着陆点，留出足够的长度以实现充分的密封和附着，而不会覆盖不必要的更多肋间动脉。将术前CTA与术中锥形束CT（CBCT）进行3D/3D融合后，将标记叠加在实时荧光透视屏幕上以进行引导。通过数字减影血管造影（DSA）确认叠加的准确性，并在需要时进行调整。支架移植物的部署由标记引导。介绍了该技术在7例患者中的初步经验。
所有病例中3D图像融合均可行。1个月后的随访CTA显示，所有计划保留的肋间动脉均通畅。所有患者均未出现脊髓缺血的迹象。
3D图像融合可用于在TEVAR期间定位肋间动脉。这可能保留一些肋间动脉并降低术后脊髓缺血的风险。
