Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

Background: Standard endovascular aortic repair (EVAR) is frequently performed with few data regarding utilization of 2D-3D fusion imaging (FI). Purpose: To evaluate a) feasibility and safety of 2D-3D FI to guide limb deployment during EVAR and b) efficacy of this technique compared to standard use of digital subtraction angiography (DSA) for guidance. Materials and Methods: Iliac limb deployment by guidance of 2D-3D FI (FUSION group, n=22 limbs) during EVAR was compared to (STANDARD group, n=23 limbs). Retrospectively, we analyzed feasibility (success-rate) and safety (patency of hypogastric artery; type Ib/III endoleak) of FI for limb deployment (FUSION group). Total contrast (ml) and median dose area product (mGy*cm2) per group to visualize the iliac bifurcation were compared. Results: In the FUSION group, limb deployment was performed in 19/22 limbs (86.4%) and all hypogastric arteries were patent at the end of the procedure. Median volumes of contrast per bifurcation were 13.0 ml (RANGE 13–13ml) in the STANDARD and 2.2ml (RANGE 0–13ml) in the FUSION group (p=0.002); median dose area products per bifurcation were 11951mGy*cm2 and 2593.1mGy*cm2 (p=0.001), respectively. Conclusion: Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions. Therefore, FI should be used whenever possible