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Semiautomatic Sizing Software in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms

  • Clinical Investigation
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CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

In emergency endovascular repair (EVAR) of ruptured aneurysms of the aorta (rAAA), anatomical suitability must be determined. Semiautomatic three-dimensional assessment of the aortoiliac arteries has the potential to standardise measurements. This study assesses the fitness for purpose of such a semiautomatic approach for rAAA and determined interobserver agreement on suitability.

Materials and Methods

Interobserver study with six trained observers (4 vascular surgeons, 2 radiologists) blindly assessing preoperative computed tomography angiography scans of 50 consecutive patients with rAAA. A central lumen line (CLL) was generated, and perpendicular diameters, length along the CLL, and EVAR suitability were determined using dedicated sizing software (3mensio; 3mensio Vascular; Bilthoven, The Netherlands). Success of generating a CLL, time of assessment, and interobserver agreement was determined.

Results

In the majority of the patients (median 76 %, range 64–78 %), a CLL was semiautomatically generated. The median duration of CLL generation and performance measurements was 7.5 min (interquartile range 5.5–10.6). Agreement on suitability was moderate for the entire group (Fleiss’ κ = 0.55, confidence interval 0.48–0.62) and ranged from moderate to good (Cohen’s κ = 0.40–0.72) between observer pairs.

Conclusion

Assessing EVAR suitability of rAAA patients using dedicated sizing software is possible in the majority of patients. The measurements can be performed in a reasonable amount of time, and the agreement of suitability for EVAR in patients with rAAA is moderate. Improvements and additional research are necessary to replace the current axial measurement.

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Acknowledgments

This study was performed in accordance with the Declaration of Helsinki. Funding was provided by the Academic Medical Centre of Amsterdam Foundation. They did not assist in the study design, the interpretation of the data, or the writing of the manuscript. The 3mensio software was provided to H. Marquering without cost for evaluation purposes.

Conflicts of interest

There were no conflicts of interest to be reported.

Author information

Authors and Affiliations

  1. Vascular Surgery Section, Department of Vascular Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Jorik J. Reimerink, Dink A. Legemate & Ron Balm

  2. Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands

    Henk A. Marquering

  3. Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands

    Henk A. Marquering, Diederick W. De Boo & Jim A. Reekers

  4. Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Anco Vahl & Michiel A. Schreve

  5. Department of Vascular Surgery, VU Medical Centre, Amsterdam, The Netherlands

    Willem Wisselink

Authors
  1. Jorik J. Reimerink
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  2. Henk A. Marquering
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  3. Anco Vahl
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  4. Michiel A. Schreve
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  5. Diederick W. De Boo
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  6. Jim A. Reekers
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  7. Dink A. Legemate
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  8. Ron Balm
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Corresponding author

Correspondence to Ron Balm.

Appendix

Appendix

Scanning protocol suspected rAAA.

Centre A

Sliding gantry Siemens Somatom Sensation 64, Erlangen, Germany. Slice thickness 3 mm, collimation 0.6 mm, reconstruction increment 0.75 mm, pitch 1.2. Contrast protocol: power injection 100 ml Ultravist 300 (Bayer Healthcare Pharmaceuticals, Germany), 5 ml/s, bolus tracking, 50 ml NaCl saline chase 5 ml/s.

Centre B

Siemens Somatom Sensation 64, Erlangen, Germany slice thickness 1.5 mm, collimation 0.6 mm, reconstruction increment 1 mm, pitch 1.2. Contrast protocol: power injection 100 ml Ultravist (Bayer Healthcare Pharmaceuticals, Germany) 300, 5 ml/s, bolus tracking.

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Reimerink, J.J., Marquering, H.A., Vahl, A. et al. Semiautomatic Sizing Software in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms. Cardiovasc Intervent Radiol 37, 623–630 (2014). https://doi.org/10.1007/s00270-013-0757-1

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  • DOI: https://doi.org/10.1007/s00270-013-0757-1

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