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Preliminary Results Of Utilizing Cine Angiography As An Alternative Modality During Visceral Vessel Cannulation To Reduce Radiation Exposure During F/BEVAR's
Nikunj Nitin Donde, MD, Bret R. Akins, CVT, Misty Humphries, MD, MAS, Steven Maximus, MD.
University of California, Davis, Sacramento, CA, USA.
OBJECTIVES:Historically digital subtraction angiography (DSA) is used selectively to cannulate visceral vessels in fenestrated and/or branched endovascular aortic repair (F/BEVAR). Here we aim to describe an alternative imaging modality to use during visceral vessel cannulation to help reduce radiation exposure. CINE mode is often utilized in interventional cardiology procedures due to the higher frame rate and lower radiation dose required to obtain images in an area with high motion artifact.
METHODS:47 F/BEVAR were performed in similar fashion at a single institution over 12 months. Procedures were performed in a hybrid operating room using a Philips Allura version 7.3 FD 20 ceiling mounted C-arm. CINE mode was attempted originally in most patients but were switched to DSA in patients where there was difficulty with visualization. This resulted in 40 F/BEVARs where DSA was used and 7 where only CINE mode was used during the visceral cannulation steps. Radiation doses, fluoro-time, contrast, and patient demographics were compared with student t-test and p-values were obtained.
RESULTS:Similar case length was observed between DSA and CINE mode F/BEVAR cases. There was a significant reduction in DAP (1921.6 vs 338.9 Gycm
2, p=0.017), Air Kerma (9261.8 vs 1974.7 mGy, p=0.0002), and fluoro time (145.6 vs 88.3 min, p=0.034) between the two modes. When comparing patient demographics, the BMI of the CINE mode patients was significantly lower at 23.4 compared to 28.6 in the DSA patients (p=0.035).
CONCLUSIONS: These data show promising results from F/BEVARs performed during a one-year period. Attempts to lower radiation dose from F/BEVAR using other adjuncts were not available due to limitations in availability at our institution. CINE mode was attempted in the latter half of the year in F/BEVAR and was found to greatly reduce radiation dose in patients with lower BMIs. In patients with larger body habitus, DSA may still be required to achieve optimal visualization.
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