Cloud-based Fusion Imaging Improves Operative Metrics during Fenestrated Endovascular Aneurysm Repair
Charles J Bailey, Jeffrey B Edwards, Marcelo Giarelli, Bruce Zwiebel, Laurence S Grundy, Murray L Shames
University of South Florida / Tampa General Hospital, Tampa, FL
INTRODUCTION: Endovascular treatment of complex aortic pathology is associated with increases in procedural-related metrics including operative time and radiation exposure. Three-dimensional fusion imaging technology has decreased radiation dose and iodinated contrast use in endovascular aneurysm repair. The aim of this study is to report our institutional experience with use of a cloud-based fusion imaging platform in fenestrated endovascular aneurysm repair (FEVAR). METHODS: A retrospective review of a prospectively maintained aortic database was performed to identify all patients who underwent commercially-available FEVAR (Zenith Fenestrated, Cook Medical, Bloomington, IN, USA) between 2013 and 2020, as well as all endovascular aneurysm repairs performed using Cydar EV Intelligent Maps (Cydar Medical, Cambridge, UK). The Cydar EV cohort was reviewed further to select all FEVAR performed with intelligent map guidance. Patient demographics, clinical, and procedural-related metrics were analyzed, with comparative analysis of FEVAR performed without- and with-Cydar EV imaging platform. Patients were excluded from comparative analysis if incomplete in dataset, or if documented history of prior open or endovascular abdominal aortic aneurysm repair. RESULTS: Over the seven-year study period 191 FEVAR were performed. The Cydar EV imaging platform was implemented in 2018 and used in 124 complex endovascular aneurysm repairs, including 69 consecutive FEVAR. A complete dataset was available on 137 FEVAR. With exclusions to select for de novo FEVAR, comparative analysis was performed on 53 FEVAR without- and 63 with-Cydar EV. Cohorts were similar with respect to patient demographics, medical comorbidities, and aortic aneurysm characteristics. No significant difference was noted between groups on major adverse postoperative events (MAPE), length of stay (LOS), or length of intensive care unit stay (LOS-ICU). Use of Cydar EV resulted in non-significant decreases in mean fluoroscopy time (69.3- vs 66.2-min, p=0.598), and a positive trend towards shorter operative times (204.4- vs 186-min, p=0.278). Notably, a statistically significant decrease in both iodinated contrast volume (104.7- vs 83.8-mL, p=0.005), and patient radiation exposure via dose-area product (DAP, 1049841- vs 630990-mGy/cm2, p<0.001) was observed in patients undergoing FEVAR with Cydar EV Intelligent Maps. CONCLUSIONS: Our Aortic Center has observed a trend towards shorter operative times, and significant reductions in both iodinated contrast use and radiation exposure during FEVAR with use of Cydar EV Intelligent Maps. Intelligent map guidance improves the efficiency of complex endovascular aneurysm repair, providing a safer intervention for both patient and practitioner.
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