Banks C Adam, Beck Adam W
Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
J Vasc Surg Cases Innov Tech. 2025 Apr 7;11(4):101803. doi: 10.1016/j.jvscit.2025.101803. eCollection 2025 Aug.
Branched/fenestrated endovascular aortic aneurysm repair (B/FEVAR) carries a risk of spinal cord ischemia (SCI), which increases along with increasing length of aortic luminal coverage of the repair. Pre-emptive coverage with first-stage thoracic endovascular aortic aneurysm repair or embolization of intercostal/lumbar vessels as a staging procedure to reduce the risk of SCI after repair has become commonplace. Intercostal/lumbar embolization can be a technically challenging procedure due to the number of vessels and multiple projections required for cannulation, leading to long procedure times and high radiation/contrast dosing, sometimes requiring multiple sessions to complete. Non-radiation-based imaging modalities such as Lumiguide Fiber Optic RealShape (FORS) by Philips has demonstrated reduction of contrast/fluoroscopy for performance of B/FEVAR and can be particularly useful for procedures requiring multiple imaging views and the resulting high fluoroscopy times/radiation dose. In this case report, we describe the successful utilization of three-dimensional overlay and FORS imaging software in preemptive segmental artery embolization before F/BEVAR to reduce the risk of SCI.
分支/开窗型血管腔内主动脉瘤修复术（B/FEVAR）存在脊髓缺血（SCI）风险，且该风险会随着修复时主动脉管腔覆盖长度的增加而升高。采用一期胸段血管腔内主动脉瘤修复术进行预防性覆盖，或作为分期手术对肋间/腰血管进行栓塞，以降低修复后发生SCI的风险，已成为常规做法。肋间/腰血管栓塞术在技术上可能具有挑战性，因为血管数量众多且插管需要多个投影角度，导致手术时间长、辐射/造影剂用量大，有时需要多次手术才能完成。基于非辐射的成像方式，如飞利浦的Lumiguide光纤真实形态（FORS），已证明可减少B/FEVAR操作中的造影剂/透视使用，对于需要多个成像视角以及由此导致高透视时间/辐射剂量的手术可能特别有用。在本病例报告中，我们描述了在F/BEVAR之前成功利用三维叠加和FORS成像软件进行节段性动脉预防性栓塞以降低SCI风险的情况。
