Use of 3D-3D DSA Spin Fusion Protocol for Complex Aorto-Iliac Endovascular Interventions

Abstract Complex endovascular aortic interventions in patients with excessive tortuosity or difficult gantry angles can be challenging. While fusion imaging helps navigate this, it is based on preoperative imaging which becomes skewed after introduction of stiff wires and large devices into the aorta. Subtraction spin protocol performs two cone-beam CT scans to create a subtracted image of the contrast filled vessels after wire and device placement to accommodate vessel distortion. A complex fenestrated endovascular aneurysm repair case with a highly angulated neck highlights the advantages of the subtraction spin protocol in anatomically hostile endovascular repairs.