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Fusion Guidance in Endovascular Peripheral Artery Interventions: A Feasibility Study

  • Clinical Investigation
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Abstract

Purpose

This study was designed to evaluate the feasibility of endovascular guidance by means of live fluoroscopy fusion with magnetic resonance angiography (MRA) and computed tomography angiography (CTA).

Methods

Fusion guidance was evaluated in 20 endovascular peripheral artery interventions in 17 patients. Fifteen patients had received preinterventional diagnostic MRA and two patients had undergone CTA. Time for fluoroscopy with MRA/CTA coregistration was recorded. Feasibility of fusion guidance was evaluated according to the following criteria: for every procedure the executing interventional radiologists recorded whether 3D road-mapping provided added value (yes vs. no) and whether PTA and/or stenting could be performed relying on the fusion road-map without need for diagnostic contrast-enhanced angiogram series (CEAS) (yes vs. no). Precision of the fusion road-map was evaluated by recording maximum differences between the position of the vasculature on the virtual CTA/MRA images and conventional angiography.

Results

Average time needed for image coregistration was 5 ± 2 min. Three-dimensional road-map added value was experienced in 15 procedures in 12 patients. In half of the patients (8/17), intervention was performed relying on the fusion road-map only, without diagnostic CEAS. In two patients, MRA roadmap showed a false-positive lesion. Excluding three patients with inordinate movements, mean difference in position of vasculature on angiography and MRA/CTA road-map was 1.86 ± 0.95 mm, implying that approximately 95 % of differences were between 0 and 3.72 mm (2 ± 1.96 standard deviation).

Conclusions

Fluoroscopy with MRA/CTA fusion guidance for peripheral artery interventions is feasible. By reducing the number of CEAS, this technology may contribute to enhance procedural safety.

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Conflict of interest

Anna M. Sailer, Rick de Graaf, Willem H. Van Zwam, Geert Willem H. Schurink, Patricia J. Nelemans have no conflicts of interest. Michiel W. de Haan reports an institutional Grant from Philips Medical Systems. Joachim E. Wildberger reports institutional grants from Siemens Healthcare, Bayer Healthcare, GE Healthcare, Philips Medical Systems, Agfa Healthcare; personal fees from Bayer, Siemens, from null, outside the submitted work. Marco Das reports institutional Grants from Philips Medical Systems, Siemens Healthcare, Bayer Healthcare and GE Healthcare.

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Authors and Affiliations

  1. Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands

    Anna M. Sailer, Michiel W. de Haan, Rick de Graaf, Willem H. van Zwam, Joachim E. Wildberger & Marco Das

  2. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Geert Willem H. Schurink

  3. Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Patricia J. Nelemans

  4. CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands

    Marco Das

Authors
  1. Anna M. Sailer
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  2. Michiel W. de Haan
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  3. Rick de Graaf
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  4. Willem H. van Zwam
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  5. Geert Willem H. Schurink
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  6. Patricia J. Nelemans
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  7. Joachim E. Wildberger
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  8. Marco Das
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Correspondence to Anna M. Sailer.

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Sailer, A.M., de Haan, M.W., de Graaf, R. et al. Fusion Guidance in Endovascular Peripheral Artery Interventions: A Feasibility Study. Cardiovasc Intervent Radiol 38, 314–321 (2015). https://doi.org/10.1007/s00270-014-0951-9

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  • DOI: https://doi.org/10.1007/s00270-014-0951-9

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