Intra-arterial computed tomography angiography during fenestrated and branched endovascular aortic repair

BackgroundImproved intraoperative diagnostic imaging during fenestrated and branched endovascular aortic repair (f-bEVAR) may reveal unfavorable positioning of endograft components, endoleaks, and other procedural complications, enabling immediate corrective maneuvers. Consequently, improved intraoperative imaging could reduce the need for follow-up computed tomography (CT) examinations and reinterventions.PurposeTo assess the feasibility of performing intraoperative CT angiography (CTA) during f-bEVAR, and to compare intraoperative CTA findings with postoperative CTA.Material and MethodsIntraoperative catheter-CTA (cCTA) with intra-arterial administration of diluted contrast medium was performed in 31 patients undergoing f-bEVAR. Intraoperative cCTA findings were compared with postoperative CTA on day 1 in 28 patients. Discrepancies in findings between the two CTA, any adjunctive corrective maneuvers, time required for cCTA imaging, radiation dose exposure, and reintervention rates were recorded.ResultsIntraoperative cCTA was technically successful in all patients (100%). Immediate corrective maneuvers were performed in 2 (7%) patients based on cCTA findings. Discrepancies between intraoperative and postoperative CTA were observed in 4/28 (14%) patients, all related to early-phase endoleaks. No discrepancies were found regarding endograft positioning or procedural complications. Mean effective dose from intraoperative cCTA was 11.3 mSv (interquartile range = 8.0-12.8).ConclusionIntraoperative cCTA during f-bEVAR was feasible and achieved a high technical success rate. It provided reliable visualization of endograft architecture and intraprocedural complications, but cCTA did not identify the same number of early-phase endoleaks as postoperative CTA. While the routine use of intraoperative cCTA may offer limited patient benefit, it can be a useful adjunct in challenging cases.