Jones Douglas W, Stangenberg Lars, Swerdlow Nicholas J, Alef Matthew, Lo Ruby, Shuja Fahad, Schermerhorn Marc L
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
Division of Vascular Surgery, Rhode Island Hospital, Alpert Medical School Brown University, Providence, RI.
Ann Vasc Surg. 2018 Oct;52:302-311. doi: 10.1016/j.avsg.2018.03.032. Epub 2018 May 22.
Practitioners of endovascular surgery have historically used 2-dimensional (2D) intraoperative fluoroscopic imaging, with intravascular contrast opacification, to treat complex 3-dimensional (3D) pathology. Recently, major technical developments in intraoperative imaging have made image fusion techniques possible, the creation of a 3D patient-specific vascular roadmap based on preoperative imaging which aligns with intraoperative fluoroscopy, with many potential benefits. First, a 3D model is segmented from preoperative imaging, typically a computed tomography scan. The model is then used to plan for the procedure, with placement of specific markers and storing of C-arm angles that will be used for intraoperative guidance. At the time of the procedure, an intraoperative cone beam computed tomography is performed, and the 3D model is registered to the patient's on-table anatomy. Finally, the system is used for live guidance in which the 3D model is codisplayed with overlying fluoroscopic images. There are many applications for image fusion in endovascular surgery. We have found it to be particularly useful for endovascular aneurysm repair (EVAR), complex EVAR, thoracic EVAR, carotid stenting, and for type 2 endoleaks. Image fusion has been shown in various settings to lead to decreased radiation dose, less iodinated contrast use, and shorter procedure times. In the future, fusion models may be able to account for vessel deformation caused by the introduction of stiff wires and devices, and the user-dependent steps may become more automated. In its current form, image fusion has already proven itself to be an essential component in the planning and success of complex endovascular procedures.
血管内手术从业者历来使用二维（2D）术中荧光透视成像，并通过血管内造影剂显影来治疗复杂的三维（3D）病变。最近，术中成像技术的重大发展使图像融合技术成为可能，即基于术前成像创建与术中荧光透视对齐的三维患者特异性血管路线图，具有许多潜在益处。首先，从术前成像（通常是计算机断层扫描）中分割出三维模型。然后使用该模型规划手术，放置特定标记并存储将用于术中引导的C形臂角度。在手术时，进行术中锥形束计算机断层扫描，并将三维模型与患者手术台上的解剖结构进行配准。最后，该系统用于实时引导，将三维模型与叠加的荧光透视图像共同显示。图像融合在血管内手术中有许多应用。我们发现它对血管内动脉瘤修复（EVAR）、复杂EVAR、胸段EVAR、颈动脉支架置入术以及2型内漏特别有用。在各种情况下，图像融合已被证明可降低辐射剂量、减少碘化造影剂的使用并缩短手术时间。未来，融合模型或许能够考虑因引入硬导线和器械而导致的血管变形，并且依赖用户的步骤可能会变得更加自动化。就其目前的形式而言，图像融合已证明自身是复杂血管内手术规划和成功的重要组成部分。
