Image Fusion 3d Road-mapping With Real-time Ivus Combined Guidance For Complex Aortic Procedures
Carla K. Scott, MD, David E. Timaran, MD, Marilisa Soto Gonzalez, MD, Fatemeh Malekpour Ghorbani, MD, Marc L. Salhanick, MD, Melissa L. Kirkwood, MD, Carlos H. Timaran, MD.
UT Southwestern, Dallas, TX, USA.
Improvements in intraoperative imaging and refinements in endovascular techniques have enhanced the safety and effectiveness of fenestrated and branched endovascular aortic aneurysm repair (F-BEVAR). The success of these repairs depends upon appropriate patient selection, accurate preoperative planning, precise intraoperative visualization of the anatomy and the proper deployment of devices. Unfavorable anatomy, however, continues to pose a challenge and exclude patients from these procedures. Consequently, to alleviate technical difficulties of complex repairs, particularly in cases of challenging anatomy, we have engaged a technique that combines live intravascular ultrasonography (IVUS) associated with image fusion 3D road-mapping to facilitate endovascular navigation and target artery cannulation in an attempt to overcome the various limitations faced by both methods. The technique reduces misalignments of the 3D overlay image, particularly those related to respiratory excursion, and the anatomic position changes that can occur during segmentation or registration. Device deployment, alignment and catheterization of the target vessels is performed under dual IVUS and 3D-fusion image guidance, avoiding the need of contrast and multiple angiography runs to adjust the alignment of the 3D mask or to assess target artery location. Live IVUS allows further adjustment of the 3D overlay not only in one 2D view, but in a 360o view. In conclusion, the combined use of IVUS and 3D-fusion imaging facilitates optimal implantation of aortic endografts and branch bridging stents during F-BEVAR, particularly in cases with challenging anatomy, while reducing the need of contrast volume and radiation exposure.
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