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. 2023 Jun;64(6):2205-2210.
doi: 10.1177/02841851231165673. Epub 2023 Apr 28.

Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

Anne Marte Schrøder-Aasen  1   2 , Ulrik Carling  1 , Trond Mogens Aaløkken  1   2 , Margrethe Kallestad Rasmussen  3 , Eric Dorenberg  1   2
Affiliations

Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

Anne Marte Schrøder-Aasen et al. Acta Radiol. 2023 Jun.

Abstract

Background: Endovascular aortic repair with fenestrated or branched endografts is technically challenging, and proper intraoperative assessment of all stent graft components with only angiography and fluoroscopy can be difficult. Intraoperative computed tomography (CT) imaging can be a valuable aid for the operators in the evaluation of stent grafting results prior to completion of surgery.

Purpose: To examine the feasibility of performing intraoperative CT imaging during fenestrated and branched endovascular aortic repair (f-bEVAR) under sterile conditions and with patients under general anesthesia.

Material and methods: Intraoperative CT imaging was performed in 10 patients undergoing elective aortic repair with fenestrated or branched endografts. Adverse events, time consumption for CT set-up and image acquisition, and additional radiation dose to the patient were recorded. CT image quality was graded. Immediate corrective maneuvers performed based on the CT findings was registered.

Results: There were no adverse events related to intraoperative CT imaging. The median additional operating time by including intraoperative CT was 16 min (interquartile range [IQR] = 12-19), comprising 7% of the median total operating time. The median estimated additional radiation dose to the patient was 4.8 mSv (IQR = 3.8-4.9). All intraoperative CT examinations were considered to be of sufficient quality for stent graft evaluation. No immediate corrective procedures were performed on the basis of CT findings in this study cohort.

Conclusion: CT imaging intraoperatively during f-bEVAR is feasible with an acceptable increase in operating time and radiation dose.

Keywords: Computed tomography; aneurysms; aorta; technology assessments; vascular.

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Conflict of interest statement

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

Figures

Fig. 1.
Fig. 1.
(a, b) The C-arm is parked away from the patient and the sliding CT scanner is positioned from the head of the operating table.
Fig. 2.
Fig. 2.
Axial image of proximal superior mesenteric branch stent (fEVAR) in (a) intraoperative and (b) postoperative CT imaging.
Fig. 3.
Fig. 3.
Reconstructed coronal image of proximal renal artery branch stents (fEVAR) in (a) intraoperative and (b) postoperative CT imaging.
Fig. 4.
Fig. 4.
Axial image of proximal left renal artery branch stent (fEVAR) in (a) intraoperative and (b) postoperative CT imaging.
Fig. 5.
Fig. 5.
Grading distribution of overall image quality in intraoperative and postoperative CT examinations.
See this image and copyright information in PMC

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