Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps

Marloes M. Jansen*, Merel van der Stelt, Stefan P.M. Smorenburg, Cornelis H. Slump, Joost A. van Herwaarden, Constantijn E.V.B. Hazenberg

*Corresponding author for this work

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Abstract

Background: This retrospective study quantifies target vessel displacement during fenestrated and branched endovascular aneurysm repair due to the introduction of stiff guidewires and stent graft delivery systems. The effect that intraoperative vessel displacement has on the usability of computed tomography angiography (CTA) roadmaps is also addressed. Methods: Patients that underwent fenestrated or branched EVAR were included in this retrospective study. Two imaging datasets were collected from each patient: (I) preoperative CTA and (II) intraoperative contrastenhanced cone beam computed tomography (ceCBCT) acquired after the insertion of the stiff guidewire and stent graft delivery system. After image registration, the 3D coordinates of the ostium of the celiac artery, superior mesenteric artery, right renal artery and left renal artery were recorded in both the CTA and the ceCBCT dataset by two observers. The three-dimensional displacement of the ostia of the target vessels was calculated by subtracting the coordinates of CTA and ceCBCT from one another. Additionally, the tortuosity index and the maximum angulation of the aorta were calculated. Results: In total 20 patients and 77 target vessels were included in this study. The ostium of the celiac, superior mesenteric, right renal and left renal artery underwent non-uniform three-dimensional displacement with mean absolute displacement of 8.2, 7.7, 8.2 and 6.2 mm, respectively. The average displacement of all different target vessels together was 7.8 mm. A moderate correlation between vessel displacement and the maximum angulation of the aortoiliac segment was found (Spearman's ρ=0.45, P<0.05). Conclusions: The introduction of stiff endovascular devices during fenestrated or branched EVAR causes significant, non-uniform displacement of the ostium of the visceral and renal target vessels. Consequently, preoperative CTA roadmaps based on bone registration are suboptimal to guide target vessel catheterization during these procedures.

Original languageEnglish
Pages (from-to)3945-3955
Number of pages11
JournalQuantitative Imaging in Medicine and Surgery
Volume11
Issue number9
DOIs
Publication statusPublished - Sep 2021

Keywords

  • Branched endovascular aneurysm repair (BEVAR)
  • Endovascular procedures
  • Fenestrated endovascular aneurysm repair (FEVAR)
  • Imaging
  • Multimodal imaging
  • Three-dimensional (3D)

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