FUSION

Pre and Intraoperative 3D Image Resources for Planning and Treatment are Mandatory to Perform Complex EVARStphan Haulon, J Sobocinski, B Maurel, T Martin Gonzalez, R Spear, A Hertault, R Azzaoui

Aortic Centre, Vascular SurgeryLille, France

DisclosuresResearch support, ConsultingCook Medical, GE Healthcare

Integrated EVAR workflow3 levels of simplificationPre-op In the ORPost-op 1-6 weeks before Procedure Following weekAssessmentFusionPlanning

Sizing and fusion preparation integrated into a planning softwareAssessmentFusionPlanning

BeforePre-op In the ORAfterSizingCTA overlay creation

Sizing & CTA overlay creation*Time saving in the ORPlanning overlay

Pre-op

Planning software RedosFragmented planning

Planning exportable to the C-armAssessmentFusionPlanning

3D overlayPlanned Landing zonesOstium outlineOptimized C-arm angulationsPlanning on CT AngioCT Angio fused in the C-arm

Recall of C-arm angulations from table-side

Overlay of Pre-Op CTA

Easy CT Angio registrationAssessmentFusionPlanning

2 Fluoro shots Table side alignment of bony structures from pre-op CT to intra-op fluoro

AssessmentFusionPlanning

Accurate fusionAssessmentFusionPlanning

Table side fine-tuning following stiff wire insertion

GE DISCOVERY IGS 730

GE DISCOVERY IGS 730

GE DISCOVERY IGS 730

Dose and contrast savingAssessmentFusionPlanningDose reduction by 40 to 59 % and contrast load by 24 to 26%

Non injected CT FusionAssessmentFusionPlanningTotal contrast throughout patients hospital stay was below 25 ml

Completion 3D angio + CE U/SAssessmentFusionPlanningIn the ORPost-op

CTA

USIn the ORPost-op

Completion DSAAssessmentBeforeAfterCompletion 3D AngioContrast savingImmediate revision Reduced costRepeated injectionsNo direct 3D asessment

Ease in 3D Angiography and good IQAssessmentFusionPlanning

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Significant reduction in overall dose and contrastAssessmentFusionPlanning-68%-50%

ConclusionEase of use and accuracy of sizing and fusion are crucial for routine useIntegrated workflow optimizes the use of pre-op dataLeveraging 3D capabilities from sizing to fusion to assessment with Cone beam CT help to reduce dose and contrast throughout patients hospital stay

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