Initial Operating Room Experience with Digital Variance Angiography in Carbon Dioxide-Assisted Lower Limb...

Area of Science:

• Medical Imaging
• Interventional Radiology
• Vascular Interventions

Background:

• Digital subtraction angiography (DSA) is a standard imaging technique.
• Digital variance angiography (DVA) has shown promise for improved image quality in prior studies.
• Carbon dioxide (CO2) is used as a contrast agent in patients with renal impairment.

Purpose of the Study:

• To evaluate the clinical usefulness and benefits of DVA in CO2-assisted lower limb interventions.
• To compare DVA with DSA in terms of image quality and diagnostic value.
• To assess the potential of DVA to improve therapeutic decision-making.

Main Methods:

• A workstation with DVA software was integrated with a Siemens Artis Zee system.
• Four patients with peripheral artery disease and impaired renal function underwent 46 CO2-assisted runs.
• DSA and DVA images were evaluated by five experts using Likert scales and paired comparisons.

Main Results:

• DVA images received significantly higher scores than DSA images (3.84 vs. 3.31, p < 0.001).
• Experts preferred DVA for diagnostic value (85.2%) and therapeutic decisions (83.9%).
• These benefits were achieved at lower frame rates (1-3 FPS) than typically used for CO2 angiography.

Conclusions:

• DVA demonstrates potential to enhance diagnostic and therapeutic decisions in CO2-assisted lower limb angiography.
• DVA may contribute to reduced radiation exposure.
• Further studies are needed to validate DVA's dose management capabilities and its role in endovascular interventions.