Impact of Calcification Modelling to Improve Image Fusion Accuracy for Endovascular Aortic Aneurysm Repair.

INTRODUCTION Since the 1990s, endovascular aortic aneurysm repair (EVAR) has become a common alternative to open surgery for the treatment of abdominal aortic aneurysms (AAAs). To aid the deployment of stent-grafts, fluoroscopic image guidance can be enhanced using pre-operative simulation and intraoperative image fusion techniques. However, the impact of Ca presence on the guidance accuracy of such techniques is yet to be considered. METHODS In the present work, we introduce a guidance tool that accounts for patient-specific Ca presence. Numerical simulations of EVAR were developed for 12 elective AAA patients, both with (With-Ca) and without (No-Ca) Ca consideration. To assess the accuracy of the simulations, the image results were overlaid on corresponding intraoperative images and the overlay error was measured at selected anatomical landmarks. RESULTS With this approach we gained insight into the impact of Ca presence on image fusion accuracy. Inclusion of Ca improved mean image fusion accuracy by 8.68 ± 4.59%. In addition, a positive correlation between the relative Ca presence and the image fusion accuracy was found (R = 0.753, P < .005). CONCLUSIONS Our results suggest that considering Ca presence in patient-specific EVAR simulations increases the reliability of EVAR image guidance techniques that utilize numerical simulation, especially for patients with severe aortic calcification presence. This article is protected by copyright. All rights reserved.