Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
J Vasc Surg. 2018 Oct;68(4):1175-1182. doi: 10.1016/j.jvs.2017.12.065. Epub 2018 Mar 31.
Endovascular procedures for aortic aneurysm repair have become widely accepted as safe and effective surgical options. We investigated the efficacy of the multimodality roadmap (MMR) system with biplane fluoroscopy to attempt to reduce the use of contrast medium and exposure to radiation during surgery.
We retrospectively reviewed 263 consecutive cases with elective endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR). Patients were categorized into two groups, with and without introduction of the MMR system, which was applied in 164 patients (62.4%). The MMR- group included 62 EVAR and 37 TEVAR cases, and the MMR+ group consisted of 81 EVAR and 83 TEVAR cases. Radiation dose, contrast medium use, and complications were compared between the MMR- and MMR+ groups in the respective EVAR and TEVAR groups.
There was a significantly lower amount of contrast medium use in the MMR+ group compared with the MMR- group in EVAR (32.9 ± 10.6 g and 28.2 ± 10.2 g; P = .009) and TEVAR (31.7 ± 11.5 g and 26.9 ± 7.8 g; P = .009). In addition, significantly lower radiation exposure was observed in the MMR+ group of TEVAR (872 ± 623 mGy vs 638 ± 463 mGy; P = .033). The operative time of the MMR+ group was significantly shorter for patients with TEVAR compared with the MMR- group (96.4 ± 27.0 minutes vs 86.2 ± 23.9 minutes; P = .023). The incidence of access injury and other complications was similar in both EVAR and TEVAR groups.
The MMR system with three-dimensional fusion imaging can reduce the contrast medium dose in EVAR and the exposure to contrast medium and radiation in TEVAR.
血管内治疗主动脉瘤修复已成为广泛接受的安全有效的手术选择。我们研究了使用双平面透视的多模态路线图（MMR）系统的疗效，试图减少手术中造影剂的使用和辐射暴露。
我们回顾性分析了 263 例择期血管内主动脉瘤修复（EVAR）和胸主动脉腔内修复（TEVAR）的连续病例。患者分为两组，一组引入 MMR 系统（164 例，62.4%），一组不引入 MMR 系统（100 例，37.6%）。MMR-组包括 62 例 EVAR 和 37 例 TEVAR，MMR+组包括 81 例 EVAR 和 83 例 TEVAR。比较 MMR-和 MMR+组在各自的 EVAR 和 TEVAR 组中的辐射剂量、造影剂使用和并发症。
在 EVAR（32.9±10.6g 和 28.2±10.2g；P=0.009）和 TEVAR（31.7±11.5g 和 26.9±7.8g；P=0.009）中，MMR+组的造影剂使用量明显低于 MMR-组。此外，在 TEVAR 的 MMR+组中，观察到明显较低的辐射暴露（872±623mGy 与 638±463mGy；P=0.033）。与 MMR-组相比，TEVAR 中 MMR+组的手术时间明显缩短（96.4±27.0 分钟与 86.2±23.9 分钟；P=0.023）。EVAR 和 TEVAR 两组的血管入路损伤和其他并发症发生率相似。
三维融合成像的 MMR 系统可减少 EVAR 中的造影剂剂量，以及 TEVAR 中的造影剂和辐射暴露。
