O-098 - ENDOVASCULAR AORTIC REPAIR WITH THE REDO FUSION TECHNIQUE

TOPIC:
New vascular techniques and devices
AUTHORS:
Tinelli G. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Minelli F. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Sica S. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Donato F. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Salman F. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Tshomba Y. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy)
Introduction:
Today's hybrid operating rooms (HOR) facilitate complex interventions with advanced radiographic imaging, such as 3‐dimensional image fusion (3D‐IF) of preoperative computed tomography (CT) images with intraoperative fluoroscopy images. This imaging technique is recognized to decrease radiation exposure for both the patient and operator during standard and complex endovascular procedure. In the presence of patients with previous endovascular devices such as stents, vascular plugs or endoprosthesis, it is possible to obtain a "Redo Fusion" image, a 3D/2D fusion in which a previously implanted endoprosthesis is considered as a fusion marker. Basically, the two types of 3D fusion images (Bone Fusion and Redo Fusion) differ according to the type of marker considered in the intraoperative phase. The choice of the right marker improves the accuracy of the image fusion procedure. The right marker achieves greater accuracy in fusion imagine reconstruction of the target vessel and therefore better preoperative orientation and navigation. In the case of Redo Fusion, therefore, this procedure is part of Endovascular Redo Aortic Surgery. The aim of this study is to demonstrate how, in the field of Endovascular Redo Aortic Surgery, the "Redo Fusion", is more accurate for the visualization of intraoperative vascular anatomy than Bone Fusion.
Methods:
This single center study prospectively analyzed 20 patients underwent elective aortic endovascular reinterventions between January 2016 and April 2021 at the Vascular Surgery Unit of the Fondazione Policlinico Universitario Gemelli - IRCCS in Rome, Italy. Procedures were performed by two expert vascular surgeons. The pre-operative 3D model was then fused with live fluoroscopy, using the 2D-3D method creating a roadmap. Overlay was performed two time: the first time using bone landmarks (Bone Fusion), the second time using radiopaque markers of previous endovascular materials implanted in the aorta (Redo fusion). Longitudinal distances between the inferior margin of the target vessel in live fluoroscopy and the inferior margin of the target vessel in Bone fusion and Redo fusion were measured.
Results:
The distance between the target vessel in the fusion image and the target vessel in the 2D fluoroscopic image was significantly lower (<1mm ± 0.25) using Redo Fusion technique than Bone Fusion technique (p-value<0.0001). The accuracy was significantly higher in case the markers of the previous endovascular materials implanted are within 3 cm of the new target vessel (p-value<0.0001) (Table 5). In addition, accuracy was statistically significant higher (<1mm ± 0.5) even when there is an angle greater than 45° between the main aortic tract and its adjacent branch near the new working area.
Conclusion:
According to our results, Redo Fusion is more accurate than Bone Fusion in endovascular reinterventions. Thus, Redo Fusion can be considered a highly refined method and currently represents a significant opportunity in the field of endovascular redo surgery.