O-095 - FIBER OPTIC REALSHAPE (FORS) IMAGING USING UPPER EXTREMITY AND TRANSFEMORAL ACCESS FOR FENESTRATED-BRANCHED ENDOVASCULAR AORTIC ANEURYSM REPAIR (F-BEVAR)

TOPIC:
New vascular techniques and devices
AUTHORS:
Pavarino F. (University of Texas Southwestern Medical Center ~ Dallas, Texas ~ United States of America) , Porras-Colon J. (University of Texas Southwestern Medical Center ~ Dallas, Texas ~ United States of America) , Gonzalez M. (University of Texas Southwestern Medical Center ~ Dallas, Texas ~ United States of America) , Pizano A. (University of Texas Southwestern Medical Center ~ Dallas, Texas ~ United States of America) , Baig M.S. (University of Texas Southwestern Medical Center ~ Dallas, Texas ~ United States of America) , Timaran C. (University of Texas Southwestern Medical Center ~ Dallas, Texas ~ United States of America)
Introduction:
Fiber Optic RealShape (FORS) technology allows real-time three-dimensional visualization of endovascular devices using light, thereby reducing radiation exposure. Although this imaging technology has increasingly been used, current experience with FORS for fenestrated-branched endovascular aortic aneurysm repair (F-BEVAR) has mostly involved transfemoral (TF) access. The purpose of this study was to describe the feasibility of using upper extremity (UE) and TF access with FORS during F-BEVAR.
Methods:
The technique is demonstrated in an 89-year-old male patient with multiple comorbidities and a type III thoracoabdominal aortic aneurysm, deemed unfit for open aortic repair. Dual fluoroscopy, intravascular ultrasound (IVUS), and 3D fusion overlay were used in addition to FORS. The docking base for the FORS system was fixed on the right side of the patient (Figure), providing sufficient wire length for target artery catheterization using TF or UE access. The technique to achieve target-vessels catheterization is described using the UE access. The time to accomplish these tasks were recorded, using the visualization of the FORS wire on the screen as start point and complete target cannulation as final point.
Results:
Using bilateral femoral artery and right brachial artery access, the AltaTrack guidewire® (0.035" / 120cm working length) was connected and registered, with two angiographic projections (AP / RAO 30°). A fenestrated custom-made device with a preloaded delivery system, manufactured by Cook Medical Inc (Bloomington, IN, USA), was used. Target artery catheterizations were successfully accomplished in 23 minutes, requiring 4 minutes and 18 seconds of fluoroscopy time, 13.45 mGy of dose area product (DAP) and 0.13 Gycm2 of reference air kerma (RAK) (Table). At the end of the case, no complication and less radiation exposure were reported, using a total of 769.62 mGy for RAK, 77 Gycm2 for DAP, and 59 minutes and 6 seconds of total fluoroscopy time.
Conclusion:
F-BEVAR with FORS technology using UE and TF access is feasible and facilitates target artery catheterization without the need of radiation. Further experience is required to demonstrate FORS benefits and applicability for F-BEVAR using both TF and UE access.
ATTACHMENTS: