Image fusion using the two-dimensional-three-dimensional registration method helps reduce contrast medium volume, fluoroscopy time, and procedure time in hybrid thoracic endovascular aortic repairs

Objective: The objective of this study was to evaluate the effect of image fusion (IF) technology in thoracic endovascular aortic repair (TEVAR) on reducing radiation exposure (dose and time), amount of injected iodinated contrast medium needed, and procedure time. Methods: We performed a review of our institutional endovascular aortic database of patients who had undergone TEVAR between2008and2016 beforeandafter the installation of a three-dimensional (3D) IFcomputedtomographysystem in our hybrid operating room. All patients were operated on using the same radiologic equipment with or without IF. Results: The 146 patients who had undergone elective or emergent TEVAR with preoperative computed tomography angiography done in 1-mm-thick slices were divided into two groups: the IF group (98 patients), in which TEVAR was performed using intraoperative IF with the two-dimensional-3D registration method; and 48 controls without the use of IF. The IF group received a significantly reduced dose of contrast material, with a median of 70 mL (interquartile range [IQR], 50-101 mL) compared with controls receiving 104 mL (IQR, 69-168 mL; P <.001). Patients who underwent hybrid TEVAR had a significantly reduced procedure time under IF guidance (n = 25) compared with controls (n = 11; median, 162 minutes [IQR, 139-199 minutes] vs 213 minutes [IQR, 189-298 minutes]; P =.015). In addition, the intraoperative fluoroscopy time was reduced to 9 minutes (IQR, 6-13 minutes) vs 23 minutes (IQR, 12-45 minutes; P <.005). However, the radiation dose (dose-area product) was similar for the two groups (P =.37). In patients who underwent plain TEVAR (n = 74) without a carotid-subclavian bypass, the IF group needed significantly less contrast material (median, 64 mL [IQR, 43-81 mL]) compared with the control group (median, 98 mL [IQR, 60-180 mL]; P =.003), whereas intraoperative radiation exposition, procedure time, and fluoroscopy time did not statistically significantly differ between the two groups. Conclusions: The IF technology using the two-dimensional-3D registration method was associated with reduced intraoperative contrast material volume in performing TEVAR. IF seemed to shorten the operation and radiation times in the more complicated (hybrid) TEVAR cases. However, a prospective study is needed to look at the dose-area product, fluoroscopy time, and procedure time in a larger cohort of patients.