Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces...

Area of Science:

• Vascular Surgery
• Medical Imaging
• Interventional Radiology

Background:

• Endovascular aortic repair (EVAR) requires precise C-arm positioning for optimal iliac bifurcation visualization.
• Traditional methods may lead to increased radiation and contrast agent use.

Purpose of the Study:

• To evaluate the feasibility and efficacy of a novel pre-operative method for calculating C-arm angulation using 3D CTA post-processing software.
• To compare this new method against a historic approach for EVAR procedures.

Main Methods:

• A retrospective analysis of 27 EVAR patients was conducted, comparing a group using the new pre-operative simulation method (NEW) with a group using the historic method (OLD).
• The new method utilized 2D simulations of C-arm angulations (oblique, cranial/caudal) derived from CTA data.
• Key metrics included the number of digital subtraction angiography runs, dose area product, and contrast volume per iliac bifurcation.

Main Results:

• The NEW group required significantly fewer angiography runs (1.0 vs 2.0 median, p=0.007) per iliac bifurcation compared to the OLD group.
• Median dose area products were substantially lower in the NEW group (11951 mGy*cm² vs 39394 mGy*cm², p=0.001).
• Contrast medium volume per iliac bifurcation was also reduced by half in the NEW group (13.0 mL vs 26 mL, p=0.007).

Conclusions:

• Pre-operative simulation of C-arm angulation using dedicated CTA post-processing software is feasible for EVAR.
• This innovative approach significantly decreases both radiation exposure and contrast medium utilization.
• The method enhances procedural efficiency and patient safety during EVAR.