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Meta-Analysis
. 2021 Feb;28(1):78-92.
doi: 10.1177/1526602820960444. Epub 2020 Sep 23.

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Sabrina A N Doelare  1 , Stefan P M Smorenburg  1 , Theodorus G van Schaik  1 , Jan D Blankensteijn  1 , Willem Wisselink  1 , Johanna H Nederhoed  1 , Rutger J Lely  2 , Arjan W J Hoksbergen  1 , Kak Khee Yeung  1   3
Affiliations
Meta-Analysis

Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Sabrina A N Doelare et al. J Endovasc Ther. 2021 Feb.

Abstract

Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR).

Materials and methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors' center. Mean differences (MDs) are presented with the 95% confidence interval (CI).

Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of -29 mL (95% CI -40.5 to -18.5, p<0.001) and -11 minutes (95% CI -21.0 to -1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD -79 mL, 95% CI -105.7 to -52.4, p<0.001), fluoroscopy time (MD -14 minutes, 95% CI -24.2 to -3.5, p<0.001), and procedure time (MD -52 minutes, 95% CI -75.7 to -27.9, p<0.001).

Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR.

Keywords: contrast volume; endovascular aneurysm repair; fenestrated/branched EVAR; fluoroscopy time; fusion imaging; image fusion; meta-analysis; procedure time; radiation dose; systematic review.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of the search strategy. EVAR, endovascular aneurysm repair.
Figure 2.
Figure 2.
Forest plots of contrast volume for (A) standard and (B) complex endovascular aneurysm repair (subgroups were analyzed for Dias et al and Hertault et al). CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 3.
Figure 3.
Forest plots of fluoroscopy time for (A) standard and (B) complex endovascular aneurysm repair (subgroups were analyzed for Dias et al). CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 4.
Figure 4.
Forest plots of radiation dose (dose area product [DAP], Gy·cm2) for (A) standard and (B) complex endovascular aneurysm repair (subgroups were analyzed for Dias et al and Hertault et al). CI, confidence interval; IV, inverse variance; SD, standard deviation.
Figure 5.
Figure 5.
Forest plots of procedure time (minutes) for (A) standard and (B) complex endovascular aneurysm repair (subgroups were analyzed for Dias et al and Hertault et al). CI, confidence interval; IV, inverse variance; SD, standard deviation.
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