Procedural Advantages of Image-Fusion Guidance over Standard EVAR: Reduced Time, Radiation, and Contrast Demand

Endovascular aneurysm repair (EVAR) can cause radiation exposure and iodinated contrast media (ICM) damage. Here, we aimed to conclude the clinical benefits of image fusion (IF) guidance in EVAR in our center and share our experience on 0 ICM usage in magnetic resonance angiography (MRA)-IF-guided EVAR and explore its feasibility.

All patients who underwent EVAR at our center between January 2018 and December 2024 were included in this study. The patients were divided into 2 groups based on whether EVAR was guided by IF. The procedure time, ICM usage, and radiation exposure of each procedure were recorded as the primary end points. Secondary end points, including technical success, endoleak, and death, were also recorded. In addition, the primary end points were compared with the results of previously published IF-guided EVAR studies. In patients with renal insufficiency or ICM allergy, we fused preoperative MRA with live fluoroscopy and applied contrast-enhanced ultrasonography to confirm the absence of endoleaks to avoid ICM usage.

During the study period, 54 patients underwent EVAR. Within this cohort, 30 patients underwent EVAR under IF guidance, while the remaining underwent traditional EVAR. IF-guided EVAR significantly reduced procedure time (IF group: 53.8 ± 20.2 vs. control group: 97.8 ± 43.0 min, P value < 0.001), ICM usage (IF group: 70.0 (51.3, 78.8) vs. control group: 150.0 (118.8, 172.5) mL, P value < 0.001), and radiation exposure (IF group: 158.5 (90.3, 322.8) vs. control group: 272.0 (220.0, 446.0) mGy, P value = 0.003) compared to traditional EVAR. In addition, we successfully performed EVAR on five patients with renal insufficiency or ICM allergy without using ICM.

IF guidance significantly reduces procedure time, ICM usage, and radiation exposure of EVAR. In addition, we have provided valuable experience on 0 ICM usage in IF-guided EVAR.