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CT-Angiographie als Grundlage der optimierten Therapieplanung vor endovaskulärer Aneurysmaausschaltung (EVAR)

Computed tomography angiography as the basis for optimized therapy planning before endovascular aneurysm repair (EVAR)

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Zusammenfassung

Die Computertomographie-Angiographie (CTA) der Aorta ist als diagnostisches Standardverfahren zur präprozeduralen Evaluation und Planung der endovaskulären Versorgung abdomineller Aortenaneurysmen („endovascular aortic repair“, EVAR) akzeptiert. Dabei liefert die CTA alle relevanten anatomischen und morphologischen Informationen über die zugrundeliegende Pathologie der Aorta und der Beckenachsen. Verschiedene Softwarelösungen zur multiplanaren Rekonstruktion der CT-Daten stehen für die exakte Vermessung der Zugangswege und der Landungszonen zur Verfügung und sind essenzieller Bestandteil der individuellen Operationsplanung. Die Synthese sämtlicher CT-basierter Informationen ermöglicht eine sichere und zielgenaue Freisetzung des Stentgrafts in der Aorta. Ferner kann die periprozedurale Strahlendosis durch eine präzise präoperative Planung der Durchleuchtungspositionen bei der Implantation reduziert werden.

Abstract

Computed tomography angiography (CTA) of the aorta is an accepted standard diagnostic procedure for preoperative evaluation and planning of endovascular treatment of abdominal aortic aneurysms (endovascular aortic repair EVAR). The CTA method delivers all relevant anatomical and morphological information on the underlying pathology of the aorta and pelvic axes. Various software solutions are available for multiplanar reconstruction of the CT data for exact measurement of the access routes and landing zones and are essential components of individualized operation planning. The synthesis of all CT-based information allows a safe and exactly targeted release of the stent graft in the aorta. Furthermore, the periprocedural radiation dose can be reduced by a precise preoperative planning of the positions to be irradiated during implantation.

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Literatur

  1. Antoniou GA, Georgiadis GS, Antoniou SA et al (2013) A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg 57:527–538

    Article  PubMed  Google Scholar 

  2. Bowman JN, Silverberg D, Ellozy S et al (2010) The role of anatomic factors in predicting success of endovascular repair of thoracic aortic aneurysms. Vasc Endovascular Surg 44:101–104

    Article  PubMed  Google Scholar 

  3. Chaikof EL, Brewster DC, Dalman RL et al (2009) The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 50:S2–S49

    Article  PubMed  Google Scholar 

  4. Elkouri S, Gloviczki P, Mckusick MA et al (2004) Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. J Vasc Surg 39:497–505

    Article  PubMed  Google Scholar 

  5. Giles KA, Pomposelli F, Hamdan A et al (2009) Decrease in total aneurysm-related deaths in the era of endovascular aneurysm repair. J Vasc Surg 49:543–550 (discussion 550–541)

    Article  PubMed  Google Scholar 

  6. Goshima S, Kanematsu M, Kondo H et al (2013) Preoperative planning for endovascular aortic repair of abdominal aortic aneurysms: feasibility of nonenhanced MR angiography versus contrast-enhanced CT angiography. Radiology, in press

  7. Greenhalgh RM, Brown LC, Kwong GP et al (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848

    Article  PubMed  CAS  Google Scholar 

  8. Hyhlik-Durr A, Bischoff MS, Hakimi M et al (2012) Technical aspects of EVAR for infrarenal AAA. J Cardiovasc Surg (Torino) 53:111–118

    Google Scholar 

  9. Jayalath RW, Mangan SH, Golledge J (2005) Aortic calcification. Eur J Vasc Endovasc Surg 30:476–488

    Article  PubMed  CAS  Google Scholar 

  10. Jonker FH, Aruny J, Muhs BE (2009) Management of type II endoleaks: preoperative versus postoperative versus expectant management. Semin Vasc Surg 22:165–171

    Article  PubMed  Google Scholar 

  11. Kilian M, Dang W, Cina CS (2010) Morphometric analysis of anatomic variables affecting endovascular stent design in patients undergoing elective and emergency repair of endovascular abdominal aortic aneurysm. Can J Surg 53:25–31

    PubMed  Google Scholar 

  12. Kritpracha B, Wolfe J, Beebe HG (2002) CT artifacts of the proximal aortic neck: an important problem in endograft planning. J Endovasc Ther 9:103–110

    Article  PubMed  Google Scholar 

  13. Lederle FA, Freischlag JA, Kyriakides TC et al (2012) Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 367:1988–1997

    Article  PubMed  CAS  Google Scholar 

  14. Leurs LJ, Kievit J, Dagnelie PC et al (2006) Influence of infrarenal neck length on outcome of endovascular abdominal aortic aneurysm repair. J Endovasc Ther 13:640–648

    Article  PubMed  Google Scholar 

  15. Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 41(Suppl 1):S1–S58

    Article  PubMed  Google Scholar 

  16. Rengier F, Weber TF, Giesel FL et al (2009) Centerline analysis of aortic CT angiographic examinations: benefits and limitations. AJR Am J Roentgenol 192:W255–W263

    Article  PubMed  Google Scholar 

  17. Saida T, Mori K, Sato F et al (2012) Prospective intraindividual comparison of unenhanced magnetic resonance imaging vs contrast-enhanced computed tomography for the planning of endovascular abdominal aortic aneurysm repair. J Vasc Surg 55:679–687

    Article  PubMed  Google Scholar 

  18. Schanzer A, Greenberg RK, Hevelone N et al (2011) Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 123:2848–2855

    Article  PubMed  Google Scholar 

  19. Sprouse LR 2nd, Meier GH 3rd, Parent FN et al (2004) Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? J Vasc Surg 40:443–447

    Article  PubMed  Google Scholar 

  20. Stacul F, Van Der Molen AJ, Reimer P et al (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21:2527–2541

    Article  PubMed  Google Scholar 

  21. Sternbergh WC 3rd, Carter G, York JW et al (2002) Aortic neck angulation predicts adverse outcome with endovascular abdominal aortic aneurysm repair. J Vasc Surg 35:482–486

    Article  PubMed  Google Scholar 

  22. Van Keulen JW, Moll FL, Tolenaar JL et al (2010) Validation of a new standardized method to measure proximal aneurysm neck angulation. J Vasc Surg 51:821–828

    Article  Google Scholar 

  23. Van Prehn J, Schlosser FJ, Muhs BE et al (2009) Oversizing of aortic stent grafts for abdominal aneurysm repair: a systematic review of the benefits and risks. Eur J Vasc Endovasc Surg 38:42–53

    Article  Google Scholar 

  24. Veith FJ, Baum RA, Ohki T et al (2002) Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 35:1029–1035

    Article  PubMed  Google Scholar 

  25. Wu MS, Boyle JR (2012) Strategies that minimize the risk of iliac limb occlusion after EVAR. J Endovasc Ther 19:86–87

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universitä München, Campus Großhadern, München, Deutschland

    F.F. Strobl, W.H. Sommer, M. Haack & K. Nikolaou

  2. Vaskuläre und endovaskuläre Chirurgie, Klinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Chirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    G. Meimarakis, T.A. Koeppel &  R. Weidenhagen FEBVS

Authors
  1. F.F. Strobl
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  2. W.H. Sommer
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  3. M. Haack
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  4. K. Nikolaou
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  5. G. Meimarakis
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  6. T.A. Koeppel
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  7. R. Weidenhagen FEBVS
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Correspondence to R. Weidenhagen FEBVS.

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Strobl, F., Sommer, W., Haack, M. et al. CT-Angiographie als Grundlage der optimierten Therapieplanung vor endovaskulärer Aneurysmaausschaltung (EVAR). Radiologe 53, 495–502 (2013). https://doi.org/10.1007/s00117-012-2450-9

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  • DOI: https://doi.org/10.1007/s00117-012-2450-9

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