The 2D-3D Registration Method in Image Fusion Is Accurate and Helps to Reduce the Used Contrast Medium, Radiation, and Procedural Time in Standard EVAR Procedures

Objective: This study aimed to evaluate the accuracy and the effectiveness of 2D-3D registration method of image fusion (IF) technology in endovascular aneurysm repair (EVAR). Methods: We performed a review of our institutional endovascular aortic database of patients who had undergone EVAR between 2011 and 2015 before and after the installation of a 3D IF computed tomography system in our hybrid operating room. Results: The accuracy was assessed in 14 endovascular procedures and showed a median registration error of 1.8 mm at the origin of the right renal artery and 1.0 mm at the origin of the left renal artery and a complete visual accuracy in 42% of the cases. EVAR was performed using the intraoperative IF technique with a 2D-3D registration method in 105 patients (group IF), whereas 47 patients done without served as controls. The IF group had a significantly reduced amount of used contrast compared with controls with a median of 58 mL and P < 0.0001. The intraoperative exposition to radiation was similar between the 2 groups with a median dose area product of 2,343.7 cGy cm(2) in the IF group and 3,219 cGy cm 2 among the controls (P = 0.457). The radiation dose in the sub group IF (including patients operated by the 2 most experienced surgeons) was lower than that in sub controls (median, 1,087 cG cm(2) vs. 2,705.3 cG cm(2), P = 0.012). The procedure time and the time of intraoperative radiation did not differ between the study groups (P = 0.117 and 0.106, respectively), as did not fluoroscopy time in the sub group IF (median, 6.3 min, vs. 9.5 min, P = 0.067), but for the 2 most experienced surgeons, the procedural time was shortened when using IF (P = 0.002). Conclusions: The 2D-3D registration method of IF guidance is accurate to delineate the vessels of interest and could help the execution of the EVAR procedures with a significantly reduced amount of contrast medium and also with reduced radiation and shorter procedural duration when surgeons are more familiar with EVAR and IF.