Portal de Periódicos da CAPES

Carta Acesso aberto Produção Nacional Revisado por pares

BIBTEX RIS

About Image Manipulation of the CTA on Software to Simulate the Appropriate Intra-operative C-arm Position

2018; Elsevier BV; Volume: 55; Issue: 6 Linguagem: Inglês

10.1016/j.ejvs.2018.02.036

1532-2165

Giovani P. Molinari,

Anatomy and Medical Technology

The study by Stahlberg et al.1Stahlberg E. Planert M. Panagiotopoulos N. Horn M. Wiedner M. Kleemann M. et al.Pre-operative simulation of the appropriate C-arm position using computed tomography post-processing software reduces radiation and contrast medium exposure during EVAR procedures.Eur J Vasc Endovasc Surg. 2017; 53: 269-274Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar shows encouraging results of contrast and radiation exposure reduction for iliac bifurcation assessment through CTA image manipulation on software, by simulating an appropriate intra-operative C-arm gantry angle, anticipating vessel visualization in orthogonal exposure related to a 3D volume reconstruction. A similar technique was described previously2Molinari G.J. Dalbem A.M. Menezes F.H. Guillaumon A.T. Proposal of renal artery's ostial projection under virtual geometric correction in infrarenal aneurysms: initial results of a pilot study.Rev Bras Cir Cardiovasc. 2014; 29: 78-82Crossref PubMed Scopus (6) Google Scholar to predetermine optimal intra-operative disposition of fluoroscopy through OsiriX. Aligning 3D points in an orthogonal projection (oriented by the lowest renal artery ostium, LRAO) automatically provides the angles to an angiographic perpendicular view of an aneurysm's neck. Stahlberg et al. use the same concept of reassembling a perpendicular to the axis vessel exposure view but with different software, likewise suitable for EVAR proximal necks. Both techniques are theoretical unfoldings of Broeders and Blankensteijn's technique.3Broeders I.A. Blankensteijn J.D. A simple technique to improve the accuracy of proximal AAA endograft deployment.J Endovasc Ther. 2000; 7: 389-393Crossref PubMed Google Scholar Other OsiriX strategies to improve EVAR were published successively.4Molinari G.J. Dalbem A.M. Guillaumon A.T. The use of virtual resources in preoperative preparation of infrarenal aneurysms: exploring the OsiriX's potential.Rev Bras Cir Cardiovasc. 2014; 29: 279-284PubMed Google Scholar, 5Molinari G.J. Dalbem A.M. Guillaumon A.T. Avoiding pitfalls of intraoperative peripheral endovascular surgery with the aid of OsiriX: expanding the use of virtual fluoroscopy.Rev Bras Cir Cardiovasc. 2014; 29: 455-458PubMed Google Scholar, 6Molinari G.J. Guillaumon A.T. Dalbem A.M. Efficacy analysis of a script-based guide for EVAR execution: is it possible to reduce patient exposure to contrast, operative time and blood loss even when advanced technologies are not available?.Braz J Cardiovasc Surg. 2015; 30: 650-656PubMed Google Scholar A preset named Virtual Fluoroscopy (VRF) was developed by manipulating tomographic values of windowing, color look up table and shading. When 3D points are put on renal arteries, they are represented volumetrically and defined related to their position in the vertebral axis. Osteo-degenerative alterations identified in VRF are recognised intra-operatively, enhancing vessel navigation without the need for consecutive angiograms to identify visceral branch positions. Furthermore, it is possible to predict an aneurysm's neck location and estimate catheter positioning for roadmapping and graft deployment. In support of Stahlberg, a further study combined LRAO projection and VRF and compared results with those from a historical group. Time for EVAR execution (and radiation), contrast use, and blood loss showed improvement after adoption of the new CTA study protocol.6Molinari G.J. Guillaumon A.T. Dalbem A.M. Efficacy analysis of a script-based guide for EVAR execution: is it possible to reduce patient exposure to contrast, operative time and blood loss even when advanced technologies are not available?.Braz J Cardiovasc Surg. 2015; 30: 650-656PubMed Google Scholar The validity and usefulness of these techniques, along with ways to adapt to the software, have increased, expanding usability to new tasks. The techniques can easily be incorporated into the surgeon's armamentarium in an attempt to avoid pitfalls and unforeseen situations (which can increase operative risk, often leading to intervention failure).