Osztrogonacz Peter, Garami Zsolt, Lumsden Alan B, Csobay-Novák Csaba, Chinnadurai Ponraj
Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, USA.
Department of Vascular and Endovascular Surgery, Semmelweis University, 68 Városmajor St, 1122 Budapest, Hungary.
J Clin Med. 2025 Jan 7;14(2):301. doi: 10.3390/jcm14020301.
: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. : A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included. The dose area product and number of DSAs were considered as primary outcomes, while projection accuracy and image fusion accuracy were considered as secondary outcomes. : A total of 79 patient were included. They were allocated to non-image fusion (NIF, n = 40), 2D3D IF (n = 14), and 3D3D IF (n = 25) groups. DAP was significantly lower both in the NIF [1542.75 µGym (751.72-3351.25 µGym), = 0.011] and 2D3D IF [1320.1 µGym (858.57-2572.07 µGym), = 0.013 groups compared to the 3D3D [2758.61 µGym (2074.73-4772.9 µGym)] cohort. In the Z3 subgroup, DAP was significantly lower in the 2D3D IF group compared to the 3D3D IF group [(1270.84 µGym (860.56-2144.69 µGym) vs. 2735.76 µGym (1583.86-5077.23 µGym), = 0.044]. 2D3D image fusion was associated with a significantly lower number of pre-deployment angiographies compared to NIF [1 (1-1) vs. 2 (1-3), = 0.031], which we used as a surrogate for contrast dose. : The entire study population analysis showed a significantly lower DAP with 2D3D IF compared to 3D3D IF, while there was no significant difference compared to NIF. It seems that stiff wire-based 2D3D IF does not cost in terms of DAP compared to NIF, while it is more favorable compared to 3D3D IF. Additionally, simple Z3 TEVAR cases might be improved by implementing the stiff wire-based 2D3D technique as a result of decreased DAP compared to 3D3D IF and decreased contrast dose compared to NIF.
本研究的目的是比较基于硬导丝的二维三维、三维三维图像融合（IF）以及非图像融合技术在简单的2区和3区胸主动脉腔内修复术（TEVAR）病例中的辐射暴露、对比剂剂量、融合及投影准确性。
基于2016年至2023年期间在我们的三级主动脉转诊中心接受TEVAR治疗的患者收集的数据，进行了一项单中心回顾性观察研究。纳入在指定期间接受2区和3区TEVAR治疗的患者。剂量面积乘积和数字减影血管造影（DSA）次数被视为主要结局，而投影准确性和图像融合准确性被视为次要结局。
共纳入79例患者。他们被分配到非图像融合（NIF，n = 40）、二维三维IF（n = 14）和三维三维IF（n = 25）组。与三维三维IF组[2758.61 μGy·m（2074.73 - 4772.9 μGy·m）]相比，NIF组[1542.75 μGy·m（751.72 - 3351.25 μGy·m），P = 0.011]和二维三维IF组[1320.1 μGy·m（858.57 - 2572.07 μGy·m），P = 0.013]的剂量面积乘积显著更低。在3区亚组中，二维三维IF组的剂量面积乘积显著低于三维三维IF组[（1270.84 μGy·m（860.56 - 2144.69 μGy·m）对2735.76 μGy·m（1583.86 - 5077.23 μGy·m），P = 0.044]。与NIF组相比，二维三维图像融合与部署前血管造影次数显著减少相关[1（1 - 1）对2（1 - 3），P = 0.031]，我们将其用作对比剂剂量的替代指标。
对整个研究人群的分析显示，与三维三维IF相比，二维三维IF的剂量面积乘积显著更低，而与NIF相比无显著差异。与NIF相比，基于硬导丝的二维三维IF在剂量面积乘积方面似乎没有成本增加，而与三维三维IF相比更具优势。此外，由于与三维三维IF相比剂量面积乘积降低，且与NIF相比对比剂剂量降低，实施基于硬导丝的二维三维技术可能会改善简单的3区TEVAR病例。
