图像融合引导技术在胸主动脉腔内修复术中左锁骨下动脉原位开窗的应用。
Image fusion guidance for left subclavian artery in situ fenestration during thoracic endovascular repair.
机构信息
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, P. R. China.
Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, P. R. China.
出版信息
J Cardiothorac Surg. 2024 Feb 22;19(1):104. doi: 10.1186/s13019-024-02561-w.
OBJECTIVES
To evaluate the feasibility and clinical benefit of utilizing image fusion for thoracic endovascular repair (TEVAR) with in situ fenestration (ISF-TEVAR).
MATERIALS AND METHODS
Between January 2020 and December 2020, we prospectively collected 18 consecutive cases with complex thoracic aortic lesions who underwent image fusion guided ISF-TEVAR. As a control group, 18 patients were collected from historical medical records from June 2019 to December 2019. The fusion group involved the use of 3D fusion of CTA and fluoroscopic images for real-time 3D guidance, and the control group involved the use of only regular fluoroscopic images for guidance. The total contrast medium volume, hand-injected contrast medium volume, overall operative time, radiation dose and fluoroscopy time were compared between the two groups. Accuracy was measured based on preoperative CTA and intraoperative digital subtraction angiography.
RESULTS
3D fusion imaging guidance was successfully implemented in all patients in the fusion group. Hand-injected contrast medium volume and overall operative time were significantly lower in the fusion group than in the control group (p = .028 and p = .011). Compared with the control group, the fusion group showed a significant reduction in time and radiation dose-area product (DAP) for fluoroscopy (p = .004 and p = .010). No significant differences in total radiation dose (DAP) or total contrast medium volume were observed (p = .079 and p = .443). Full accuracy was achieved in 8 cases (44%), with a mean deviation of 2.61 mm ± 3.1 (range 0.0-8.4 mm).
CONCLUSIONS
3D image fusion for ISF-TEVAR was associated with a significant reduction in hand-injected contrast medium, time and radiation exposure for fluoroscopy and overall operative time. The image fusion guidance showed potential clinical benefits towards improved treatment safety and accuracy for complex thoracic endovascular interventions.
目的
评估在原位开窗（ISF-TEVAR）胸主动脉腔内修复术中使用图像融合的可行性和临床获益。
材料和方法
2020 年 1 月至 2020 年 12 月，前瞻性地收集了 18 例接受图像融合引导 ISF-TEVAR 的复杂胸主动脉病变患者。作为对照组，从 2019 年 6 月至 2019 年 12 月的历史病历中收集了 18 例患者。融合组采用 CTA 和透视图像的 3D 融合进行实时 3D 引导，对照组仅采用常规透视图像进行引导。比较两组的总造影剂用量、手推造影剂用量、总手术时间、辐射剂量和透视时间。根据术前 CTA 和术中数字减影血管造影术（DSA）评估准确性。
结果
融合组所有患者均成功实施 3D 融合成像引导。与对照组相比，融合组手推造影剂用量和总手术时间明显减少（p=0.028 和 p=0.011）。与对照组相比，融合组透视时间和射线剂量面积乘积（DAP）明显减少（p=0.004 和 p=0.010）。总辐射剂量（DAP）和总造影剂用量无显著差异（p=0.079 和 p=0.443）。8 例（44%）完全准确，平均偏差 2.61±3.1（0.0-8.4mm）。
结论
在 ISF-TEVAR 中使用 3D 图像融合可显著减少手推造影剂、透视时间和射线剂量以及总手术时间。图像融合引导对复杂胸主动脉腔内介入治疗的安全性和准确性有潜在的临床获益。
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