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FT22. Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins—When and Why It Happened?
Journal of Vascular Surgery
Abstracts
25S
Volume 65, Number 6S whereas established macrocalcification visible on CT may reflect a quiescent biological state. 18F-NaF PET-CT has the potential to improve the management of patients with AAA by identifying those at risk of rapid disease progression or requiring aneurysm repair.
Table II. Clinical outcomes Outcome Complication
Author Disclosures: R. O. Forsythe: Nothing to disclose; T. Investigators: Nothing to disclose.
Direct therapy Staged therapy (n ¼ 46) (n ¼ 45) P value 0
0
Major bleeding
0
0
NS NS
Minor bleeding
0
1
NS
Pulmonary embolism
0
0
NS
FT21.
Renal failure
0
0
NS
Comparison of Direct Iliofemoral Stenting With Staged Stenting After AngioJet Rheolytic Thrombectomy in Patients With Acute Deep Vein Thrombosis
30-day mortality
0
0
NS
Recurrent DVT
2
0
NS
Preoperation
11.68 6 1.92
12.17 6 2.29
Postoperation
3.21 6 1.44
2.36 6 1.19
.0000
81.50 6 5.76
85.67 6 3.84
.0000
Venous reflux
1.36 6 0.46
1.26 6 0.41
.139
Villalta scale
4.20 6 2.47
2.13 6 1.91
.0001
Postprocedural patency (VRI)
Guang Liu, Weimin Li, Xinwu Lu, Mier Jiang. Shanghai 9th People’s Hospital Objectives: Early percutaneous rheolytic thrombectomy (RT) can potentially decrease the risk of post-thrombotic syndrome (PTS) by restoring venous patency and preserving valvular function by rapid clot remove. Direct iliofemoral stenting or staged stenting with catheterdirected thrombolysis (CDT) after AngioJet RT is still a matter of debate. This study was undertaken to compare the efficacy and treatment outcomes of patients with acute proximal deep vein thrombosis (DVT) of the lower limb accompanied with iliofemoral stenosis who underwent direct or staged stenting with CDT after RT. Methods: Ninety-one patients with acute proximal DVT of the lower limb who were diagnosed by ultrasound imaging were divided into two treatment groups: one group received direct stenting after RT, and the other received staged stenting after RT+CDT. Comparisons were made with regards to the treatment outcome between the two groups. Venous Registry Index was used to evaluate the postprocedural patency, and PTS was assessed using the Villalta scale. Results: Forty-six patients in direct group and 45 in the staged group were followed up for 1 year. The technical success was 100% in both groups, without any 30-day mortality. Recurrent DVT was occurred in two patients in direct group.VRI changed from 11.68 6 1.92 preoperatively to 3.21 6 1.44 postoperatively in the direct group and from 12.17 6 2.29 to 2.36 6 1.19 in the staged group. The thrombolysis rate was 81.50 6 5.76 and 85.67 6 3.84 in the direct and staged groups, respectively (P < .01; Table I). There were no differences in complications, thrombus score, and VRI between the two groups. Immediate (24 hours) improvement in clinical symptoms in direct and staged groups was achieved in 42 (81%) and 33 (72%) cases, respectively (not significant). Significant reductions in hospital lengths of stay were noted in the direct group (4.59 6 0.91) when compared to the staged group (5.8 6 1.6). The Villalta scale was 4.20 6 2.47 in the direct group and 2.13 6 1.91 in the staged group (P < .001). Primary patency rate at 1 year was 93.5% in the direct group and 97.8% in the staged group (P ¼ .323; Table II). Conclusions: Both direct and staged stenting are effective treatment modalities in patients with acute proximal DVT. Compared with staged,
Table I. Patient demographic and treatment outcome in the treatment groups
Variable
Direct therapy (n ¼ 46)
Staged therapy (n ¼ 45) P value
Age, mean y
54.8
56.5
Male, No. (%)
32 (69)
27 (60)
Thrombolysis grade, No. 3
1
2
26
23
3 Overall hospital length of stay, days
NS, Not significant.
NS NS
1
Immediate clinical improvement, No. (%)
NS
23 43 (93)
25 31 (69%) <.001
4.59 6 0.91 5.8 6 1.6 <.001
Thrombolysis rate (%)
.194
12-month clinical outcome
NS, Not significant; VRI, venous Registry Index.
direct provides similar treatment success and significant reductions in hospital lengths of stay but with more risk of PTS at 1-year follow-up. Author Disclosures: M. Jiang: Nothing to disclose; W. Li: Nothing to disclose; G. Liu: Nothing to disclose; X. Lu: Nothing to disclose.
FT22. Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose VeinsdWhen and Why It Happened? Atsushi Kitagawa, Toshihiko Nagao. Ako Central Hospital, Ako, Japan Objectives: This study was conducted to elucidate the occurrence rate, timing, and risk factors of endovenous heat-induced thrombosis (EHIT) after radiofrequency ablation (RFA) for varicose veins of lower extremities. Methods: A single-center prospective RFA trial enrolled 224 legs in 185 patients with varicose veins (2014 to 2016), of which 162 legs in 144 patients (mean age, 67 years; 100 legs in females) had varicose veins of great saphenous vein (GSV). Postoperative assessment with duplex ultrasound imaging was conducted for all of the patients after RFA at 1, 7, 30, and 90 days. Outcome analyses included the occurrence rate, timing of EHIT based on the Kabnick classification. The univariate and multiple logistic regression analyses of EHIT risk factors were conducted in relation to age (>75 years old), female gender, CEAP Clinical class $3, adjunct procedures (stab avulsion/partial stripping), prior history of vein surgery, and GSV diameter >7.5 mm. Also, the distance between superficial epigastric vein (SEV) and saphenofemoral junction (SFJ) was measured and analyzed in association with EHIT in the latest 60 RFA cases (defined as the SEV-SFJD) with c2 test (34 legs with EHIT vs 26 without EHIT). Results: The EHIT occurred in 44 legs (27%; EHIT class 1: 21%, class $2: 6%). EHIT was found in 12%, 21%, 5.5%, and 0.6% of legs at 1, 7, 30, and 90 days, respectively. The strong risk factors of EHIT after RFA were CEAP Clinical class $3 and GSV diameter >7.5 mm in univariate analysis, both of which were also the strong risk factors after RFA on multiple logistic regression analysis (CEAP Clinical class $3: odds ratio, 2.58; 95% confidence interval, 1.21-5.48, P ¼ .013; GSV diameter >7.5 mm: odds ratio 3.50; 95% confidence interval, 1.61-7.60, P ¼ .0015). The SEV-SFJD was 5.2 6 3.6 mm (with EHIT) and 6.5 6 2.7 mm (without EHIT), respectively. The SEV-SFJD <4.0 mm was found more in legs with EHIT (19 legs [56%]) than those without EHIT (4 legs [15%]), with statistical significance (P ¼ .001). Conclusions: EHIT was found mostly on day 7 after RFA for GSV. Postoperative surveillance with duplex ultrasound imaging is important to prevent thromboembolism for the patients, especially with CEAP Clinical class $3 or GSV diameter >7.5 mm. The SEV-SFJD <4.0 mm might be associated with EHIT after RFA.
26S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 Author Disclosures: A. Kitagawa: Nothing to disclose; T. Nagao: Nothing to disclose.
V2: VESS PAPER SESSION 2 VESS17. Upper Extremity Access for Fenestrated-Branched Endovascular Aortic Repair Aleem Mirza, MD,1 Gustavo S. Oderich, MD,1 Victor Davila, MD,2 Giuliano Sandri, MD,3 Jan Hofer, MD,2 Jean Wigham, MD,2 Stephen Cha, MD2. 1Mayo Clinic, Rochester, Minn; 2Mayo Clinic, Phoenix, Ariz; 3 University of Porto, Porto, Portugal Objectives: Upper extremity (UE) access during fenestrated-branched endovascular aortic repair (F-BEVAR) facilitates catheterization of mesenteric arteries but carries added risk of arterial injury and neurologic complications. The aim of this study was to assess outcomes of F-BEVAR using UE access. Methods: We reviewed the clinical data of 334 consecutive patients treated by F-BEVAR (2007-2016). Patients who had procedures with UE arterial access for renal-mesenteric catheterization were included in the study. End points were technical success, mortality, stroke, peripheral nerve injury, UE arterial complications (dissection, thrombosis, hematoma requiring intervention, pseudoaneurysm, or distal embolization), and freedom from UE thrombosis or reintervention. Results: There were 243 patients (74% male; mean age, 75 6 8 years) treated for 148 thoracoabdominal and 95 pararenal aortic aneurysms using UE arterial access. A total of 838 renal-mesenteric arteries were incorporated by fenestrations or branches (3.4 6 0.3 vessels/patient). UE arterial access was performed using surgical exposure of the proximal brachial artery in 171 patients, distal brachial artery in 62, or infraclavicular axillary artery in nine. Access was left-sided in 228 patients (94%) and right-sided in 15 (6%). Large-profile sheaths (10F-12F) were used in 159 patients (66%) and smaller profile (7F-8F) in 84 (34%). Technical success of target vessel incorporation was achieved in 99% (829 of 838). Thirty-day mortality was 2.5% (6 of 243). UE arterial complications occurred in 8 patients (4%), including focal dissection in 5 (2%), and transection, in situ thrombosis or hematoma requiring surgical evacuation in 1 patient each. Flow-limiting UE arterial lesions were diagnosed intraoperatively and successfully treated by patch angioplasty in six patients and interposition vein graft in one. Two patients (1%) developed UE peripheral nerve neurapraxia. There were no pseudoaneurysms or distal embolizations. Four patients (2%) had stroke (3 minor, 1 major), which were more frequent with right-sided compared to leftsided UE arterial access (2 [13%] vs 2 [0.9%]; P < .001). Stroke was not associated with type of aortic arch, sheath profile, or presence of subclavian artery calcification or partial thrombus (P > .05). Mean follow-up was 38 6 15 months. There were no late UE arterial stenoses, thromboses, accessrelated complications, or reinterventions. Conclusions: UE arterial access using surgical exposure and largediameter sheaths was associated with low rates of complications, stroke, and peripheral nerve injuries in patients treated by F-BEVAR. Left-sided UE access was associated with lower stroke rates. Author Disclosures: S. Cha: Nothing to disclose; V. Davila: Nothing to disclose; J. Hofer: Nothing to disclose; A. K. Mirza: Nothing to disclose; G. Oderich: Nothing to disclose; G. de A. Sandri: Nothing to disclose; J. Wigham: Nothing to disclose.
VESS18. CTA-Fluoroscopy Image Fusion Guidance Allows Visceral Vessel Cannulation Without Angiograms During Fenestrated Endovascular Aortic Repair Adeline Schwein, Ponraj Chinnadurai, Alan B. Lumsden, Jean Bismuth, Carlos F. Bechara. Houston Methodist Hospital, Houston, Tex Objectives: Fenestrated endovascular aortic repair (FEVAR) is an evolving technique to treat juxtarenal aortic aneurysms. Catheterization of renal arteries and superior mesenteric artery (SMA) after the main body of device deployment is often challenging, usually requiring multiple cine angiograms. The aim of our study was to assess the accuracy and
Fig. Custom developed binary qualitative assessment scale. CTA, computed tomography angiography; FEVAR, fenestrated endovascular aortic repair.
utility of CTA-fluoroscopy image fusion technique to cannulate visceral vessels during FEVAR. Methods: Between August 2014 and September 2016, all patients who underwent FEVAR using image fusion guidance were included. Preoperative computed tomography angiography (CTA) images were fused with intraoperative fluoroscopy after coregistering with a noncontrast conebeam CT (syngo iGuideToolbox, syngoDynaCT, Siemens Healthcare). The ostia of the visceral vessels were electronically marked on CTA images and overlaid on live fluoroscopy to guide vessel cannulation after fenestrated device deployment. Accuracy of image fusion was retrospectively evaluated from video recordings by three experts using a customdeveloped binary qualitative assessment scale (Fig 1). Utility of image fusion was evaluated by assessing the number of angiograms required for each visceral vessel cannulation. Results: A total of 26 patients (17 men; mean age, 73.8 years) underwent FEVAR during the study period. Based on the availability of case recordings, of the 45 visceral vessel ostia that were evaluated qualitatively, 32 of 36 renal ostia (89%) and eight of nine SMA ostia (89%) were accurate. Of the 62 visceral vessels that were cannulated, 37 of 50 renal arteries (74%) and 10 of 12 SMAs (83%) were cannulated using the virtual ostia from image fusion only, without the need for a dedicated angiogram. Conclusions: Our study demonstrates that preoperative CTA-fluoroscopy image fusion guidance during FEVAR is a valuable and accurate tool that allowed visceral vessel cannulation without the need of dedicated angiogram. Such techniques can help with reducing the risk of contrast-induced nephrotoxicity, and reducing radiation exposure from cine angiograms. Author Disclosures: C. F. Bechara: Cook Medical: consulting fees (eg, advisory boards), speaker’s bureau; J. Bismuth: Nothing to disclose; P. Chinnadurai: Siemens Medical Solutions USA Inc: salary; A. B. Lumsden: Cook Medical: other financial or material support, Siemens Medical Solutions USA Inc: consulting fees (eg, advisory boards); A. Schwein: Nothing to disclose.
VESS19. Upper Extremity Interventions for Critical Ischemia Mark G. Davies, Mark G. Davies, Taylor D. Hicks, Maureen K. Sheehan, Lori L. Pounds, Matthew J. Sideman. University of Texas, San Antonio, Tex
Abstracts
25S
Volume 65, Number 6S whereas established macrocalcification visible on CT may reflect a quiescent biological state. 18F-NaF PET-CT has the potential to improve the management of patients with AAA by identifying those at risk of rapid disease progression or requiring aneurysm repair.
Table II. Clinical outcomes Outcome Complication
Author Disclosures: R. O. Forsythe: Nothing to disclose; T. Investigators: Nothing to disclose.
Direct therapy Staged therapy (n ¼ 46) (n ¼ 45) P value 0
0
Major bleeding
0
0
NS NS
Minor bleeding
0
1
NS
Pulmonary embolism
0
0
NS
FT21.
Renal failure
0
0
NS
Comparison of Direct Iliofemoral Stenting With Staged Stenting After AngioJet Rheolytic Thrombectomy in Patients With Acute Deep Vein Thrombosis
30-day mortality
0
0
NS
Recurrent DVT
2
0
NS
Preoperation
11.68 6 1.92
12.17 6 2.29
Postoperation
3.21 6 1.44
2.36 6 1.19
.0000
81.50 6 5.76
85.67 6 3.84
.0000
Venous reflux
1.36 6 0.46
1.26 6 0.41
.139
Villalta scale
4.20 6 2.47
2.13 6 1.91
.0001
Postprocedural patency (VRI)
Guang Liu, Weimin Li, Xinwu Lu, Mier Jiang. Shanghai 9th People’s Hospital Objectives: Early percutaneous rheolytic thrombectomy (RT) can potentially decrease the risk of post-thrombotic syndrome (PTS) by restoring venous patency and preserving valvular function by rapid clot remove. Direct iliofemoral stenting or staged stenting with catheterdirected thrombolysis (CDT) after AngioJet RT is still a matter of debate. This study was undertaken to compare the efficacy and treatment outcomes of patients with acute proximal deep vein thrombosis (DVT) of the lower limb accompanied with iliofemoral stenosis who underwent direct or staged stenting with CDT after RT. Methods: Ninety-one patients with acute proximal DVT of the lower limb who were diagnosed by ultrasound imaging were divided into two treatment groups: one group received direct stenting after RT, and the other received staged stenting after RT+CDT. Comparisons were made with regards to the treatment outcome between the two groups. Venous Registry Index was used to evaluate the postprocedural patency, and PTS was assessed using the Villalta scale. Results: Forty-six patients in direct group and 45 in the staged group were followed up for 1 year. The technical success was 100% in both groups, without any 30-day mortality. Recurrent DVT was occurred in two patients in direct group.VRI changed from 11.68 6 1.92 preoperatively to 3.21 6 1.44 postoperatively in the direct group and from 12.17 6 2.29 to 2.36 6 1.19 in the staged group. The thrombolysis rate was 81.50 6 5.76 and 85.67 6 3.84 in the direct and staged groups, respectively (P < .01; Table I). There were no differences in complications, thrombus score, and VRI between the two groups. Immediate (24 hours) improvement in clinical symptoms in direct and staged groups was achieved in 42 (81%) and 33 (72%) cases, respectively (not significant). Significant reductions in hospital lengths of stay were noted in the direct group (4.59 6 0.91) when compared to the staged group (5.8 6 1.6). The Villalta scale was 4.20 6 2.47 in the direct group and 2.13 6 1.91 in the staged group (P < .001). Primary patency rate at 1 year was 93.5% in the direct group and 97.8% in the staged group (P ¼ .323; Table II). Conclusions: Both direct and staged stenting are effective treatment modalities in patients with acute proximal DVT. Compared with staged,
Table I. Patient demographic and treatment outcome in the treatment groups
Variable
Direct therapy (n ¼ 46)
Staged therapy (n ¼ 45) P value
Age, mean y
54.8
56.5
Male, No. (%)
32 (69)
27 (60)
Thrombolysis grade, No. 3
1
2
26
23
3 Overall hospital length of stay, days
NS, Not significant.
NS NS
1
Immediate clinical improvement, No. (%)
NS
23 43 (93)
25 31 (69%) <.001
4.59 6 0.91 5.8 6 1.6 <.001
Thrombolysis rate (%)
.194
12-month clinical outcome
NS, Not significant; VRI, venous Registry Index.
direct provides similar treatment success and significant reductions in hospital lengths of stay but with more risk of PTS at 1-year follow-up. Author Disclosures: M. Jiang: Nothing to disclose; W. Li: Nothing to disclose; G. Liu: Nothing to disclose; X. Lu: Nothing to disclose.
FT22. Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose VeinsdWhen and Why It Happened? Atsushi Kitagawa, Toshihiko Nagao. Ako Central Hospital, Ako, Japan Objectives: This study was conducted to elucidate the occurrence rate, timing, and risk factors of endovenous heat-induced thrombosis (EHIT) after radiofrequency ablation (RFA) for varicose veins of lower extremities. Methods: A single-center prospective RFA trial enrolled 224 legs in 185 patients with varicose veins (2014 to 2016), of which 162 legs in 144 patients (mean age, 67 years; 100 legs in females) had varicose veins of great saphenous vein (GSV). Postoperative assessment with duplex ultrasound imaging was conducted for all of the patients after RFA at 1, 7, 30, and 90 days. Outcome analyses included the occurrence rate, timing of EHIT based on the Kabnick classification. The univariate and multiple logistic regression analyses of EHIT risk factors were conducted in relation to age (>75 years old), female gender, CEAP Clinical class $3, adjunct procedures (stab avulsion/partial stripping), prior history of vein surgery, and GSV diameter >7.5 mm. Also, the distance between superficial epigastric vein (SEV) and saphenofemoral junction (SFJ) was measured and analyzed in association with EHIT in the latest 60 RFA cases (defined as the SEV-SFJD) with c2 test (34 legs with EHIT vs 26 without EHIT). Results: The EHIT occurred in 44 legs (27%; EHIT class 1: 21%, class $2: 6%). EHIT was found in 12%, 21%, 5.5%, and 0.6% of legs at 1, 7, 30, and 90 days, respectively. The strong risk factors of EHIT after RFA were CEAP Clinical class $3 and GSV diameter >7.5 mm in univariate analysis, both of which were also the strong risk factors after RFA on multiple logistic regression analysis (CEAP Clinical class $3: odds ratio, 2.58; 95% confidence interval, 1.21-5.48, P ¼ .013; GSV diameter >7.5 mm: odds ratio 3.50; 95% confidence interval, 1.61-7.60, P ¼ .0015). The SEV-SFJD was 5.2 6 3.6 mm (with EHIT) and 6.5 6 2.7 mm (without EHIT), respectively. The SEV-SFJD <4.0 mm was found more in legs with EHIT (19 legs [56%]) than those without EHIT (4 legs [15%]), with statistical significance (P ¼ .001). Conclusions: EHIT was found mostly on day 7 after RFA for GSV. Postoperative surveillance with duplex ultrasound imaging is important to prevent thromboembolism for the patients, especially with CEAP Clinical class $3 or GSV diameter >7.5 mm. The SEV-SFJD <4.0 mm might be associated with EHIT after RFA.
26S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 Author Disclosures: A. Kitagawa: Nothing to disclose; T. Nagao: Nothing to disclose.
V2: VESS PAPER SESSION 2 VESS17. Upper Extremity Access for Fenestrated-Branched Endovascular Aortic Repair Aleem Mirza, MD,1 Gustavo S. Oderich, MD,1 Victor Davila, MD,2 Giuliano Sandri, MD,3 Jan Hofer, MD,2 Jean Wigham, MD,2 Stephen Cha, MD2. 1Mayo Clinic, Rochester, Minn; 2Mayo Clinic, Phoenix, Ariz; 3 University of Porto, Porto, Portugal Objectives: Upper extremity (UE) access during fenestrated-branched endovascular aortic repair (F-BEVAR) facilitates catheterization of mesenteric arteries but carries added risk of arterial injury and neurologic complications. The aim of this study was to assess outcomes of F-BEVAR using UE access. Methods: We reviewed the clinical data of 334 consecutive patients treated by F-BEVAR (2007-2016). Patients who had procedures with UE arterial access for renal-mesenteric catheterization were included in the study. End points were technical success, mortality, stroke, peripheral nerve injury, UE arterial complications (dissection, thrombosis, hematoma requiring intervention, pseudoaneurysm, or distal embolization), and freedom from UE thrombosis or reintervention. Results: There were 243 patients (74% male; mean age, 75 6 8 years) treated for 148 thoracoabdominal and 95 pararenal aortic aneurysms using UE arterial access. A total of 838 renal-mesenteric arteries were incorporated by fenestrations or branches (3.4 6 0.3 vessels/patient). UE arterial access was performed using surgical exposure of the proximal brachial artery in 171 patients, distal brachial artery in 62, or infraclavicular axillary artery in nine. Access was left-sided in 228 patients (94%) and right-sided in 15 (6%). Large-profile sheaths (10F-12F) were used in 159 patients (66%) and smaller profile (7F-8F) in 84 (34%). Technical success of target vessel incorporation was achieved in 99% (829 of 838). Thirty-day mortality was 2.5% (6 of 243). UE arterial complications occurred in 8 patients (4%), including focal dissection in 5 (2%), and transection, in situ thrombosis or hematoma requiring surgical evacuation in 1 patient each. Flow-limiting UE arterial lesions were diagnosed intraoperatively and successfully treated by patch angioplasty in six patients and interposition vein graft in one. Two patients (1%) developed UE peripheral nerve neurapraxia. There were no pseudoaneurysms or distal embolizations. Four patients (2%) had stroke (3 minor, 1 major), which were more frequent with right-sided compared to leftsided UE arterial access (2 [13%] vs 2 [0.9%]; P < .001). Stroke was not associated with type of aortic arch, sheath profile, or presence of subclavian artery calcification or partial thrombus (P > .05). Mean follow-up was 38 6 15 months. There were no late UE arterial stenoses, thromboses, accessrelated complications, or reinterventions. Conclusions: UE arterial access using surgical exposure and largediameter sheaths was associated with low rates of complications, stroke, and peripheral nerve injuries in patients treated by F-BEVAR. Left-sided UE access was associated with lower stroke rates. Author Disclosures: S. Cha: Nothing to disclose; V. Davila: Nothing to disclose; J. Hofer: Nothing to disclose; A. K. Mirza: Nothing to disclose; G. Oderich: Nothing to disclose; G. de A. Sandri: Nothing to disclose; J. Wigham: Nothing to disclose.
VESS18. CTA-Fluoroscopy Image Fusion Guidance Allows Visceral Vessel Cannulation Without Angiograms During Fenestrated Endovascular Aortic Repair Adeline Schwein, Ponraj Chinnadurai, Alan B. Lumsden, Jean Bismuth, Carlos F. Bechara. Houston Methodist Hospital, Houston, Tex Objectives: Fenestrated endovascular aortic repair (FEVAR) is an evolving technique to treat juxtarenal aortic aneurysms. Catheterization of renal arteries and superior mesenteric artery (SMA) after the main body of device deployment is often challenging, usually requiring multiple cine angiograms. The aim of our study was to assess the accuracy and
Fig. Custom developed binary qualitative assessment scale. CTA, computed tomography angiography; FEVAR, fenestrated endovascular aortic repair.
utility of CTA-fluoroscopy image fusion technique to cannulate visceral vessels during FEVAR. Methods: Between August 2014 and September 2016, all patients who underwent FEVAR using image fusion guidance were included. Preoperative computed tomography angiography (CTA) images were fused with intraoperative fluoroscopy after coregistering with a noncontrast conebeam CT (syngo iGuideToolbox, syngoDynaCT, Siemens Healthcare). The ostia of the visceral vessels were electronically marked on CTA images and overlaid on live fluoroscopy to guide vessel cannulation after fenestrated device deployment. Accuracy of image fusion was retrospectively evaluated from video recordings by three experts using a customdeveloped binary qualitative assessment scale (Fig 1). Utility of image fusion was evaluated by assessing the number of angiograms required for each visceral vessel cannulation. Results: A total of 26 patients (17 men; mean age, 73.8 years) underwent FEVAR during the study period. Based on the availability of case recordings, of the 45 visceral vessel ostia that were evaluated qualitatively, 32 of 36 renal ostia (89%) and eight of nine SMA ostia (89%) were accurate. Of the 62 visceral vessels that were cannulated, 37 of 50 renal arteries (74%) and 10 of 12 SMAs (83%) were cannulated using the virtual ostia from image fusion only, without the need for a dedicated angiogram. Conclusions: Our study demonstrates that preoperative CTA-fluoroscopy image fusion guidance during FEVAR is a valuable and accurate tool that allowed visceral vessel cannulation without the need of dedicated angiogram. Such techniques can help with reducing the risk of contrast-induced nephrotoxicity, and reducing radiation exposure from cine angiograms. Author Disclosures: C. F. Bechara: Cook Medical: consulting fees (eg, advisory boards), speaker’s bureau; J. Bismuth: Nothing to disclose; P. Chinnadurai: Siemens Medical Solutions USA Inc: salary; A. B. Lumsden: Cook Medical: other financial or material support, Siemens Medical Solutions USA Inc: consulting fees (eg, advisory boards); A. Schwein: Nothing to disclose.
VESS19. Upper Extremity Interventions for Critical Ischemia Mark G. Davies, Mark G. Davies, Taylor D. Hicks, Maureen K. Sheehan, Lori L. Pounds, Matthew J. Sideman. University of Texas, San Antonio, Tex