Overlay of 3D Scans on Live Fluoroscopy for Endovascular Procedures in the Hybrid OR
Condition: Abdominal Aortic Aneurysm (AAA); Thoracic Aortic Aneurysm (TAA); Carotid Stenosis; Visceral Artery Aneurysm
MeSH terms: Carotid Stenosis; Aneurysm; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic
Study type: Observational

Summary: 
      As endovascular procedures become more complex, there is a growing need for 3D image overlay
      to assist with device guidance and placement. Currently, a 3D image is typically created
      intra-operatively using 3D rotational angiography (3D-RA) or cone-beam CT (XperCT). This 3D
      image may then be overlaid on live fluoroscopy to provide 3D guidance information (Dynamic 3D
      Roadmapping). Philips Healthcare multimodality overlay products allows registration of a
      pre-acquired MR/CT or 3D rotational image to live fluoroscopy.
    

Detailed description: 
      Endovascular treatment is performed under the guidance of an X-ray angiography system.
      Fluoroscopy and conventional 2D digital subtraction angiography (DSA) are used to navigate
      the interventional device (and implant) across the lesion to achieve a correct bridging of
      the diseased region of the vessel, while excluding the involvement of patent vessels.
      Drawbacks of these peripheral interventions include the radiation dose, use of contrast, and
      need for a clinician with excellent wire-handling skills. The use of 2D imaging alone may not
      be enough to describe the three-dimensional(3D) relationship between interventional devices
      (and implants) and the complex vascular anatomy, often making positioning, deployment and
      evaluation suboptimal. In addition, the endovascular approach can lead to complications such
      as in-stent thrombosis and type II endoleak (in the case of aortic aneurysms) for which 2D
      imaging along is again sub-optimal for re-intervention planning and guidance.

      As endovascular procedures become more complex, there is a growing need for 3D image overlay
      to assist with device guidance and placement. Currently, a 3D image is typically created
      intra-operatively using 3D rotational angiography (3D-RA) or cone-beam CT (XperCT). This 3D
      image may then be overlaid on live fluoroscopy to provide 3D guidance information (Dynamic 3D
      Roadmapping). 3D navigation can also be acquired by registration of a pre-acquired MR/CT or
      3D rotational image to live fluoroscopy.
    

Intervention name(s): Endovascular Aortic Repair (EVAR)
Intervention type(s): Other
Intervention description(s): Use of 3D interventional imaging tools in endovascular procedures in the surgical environment
Other intervention name(s): EVAR, TEVAR
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with age 18-90, of both genders and all races Patients undergoing elective AAA or
        TAA repair or carotid stenting or peripheral intervention Patients already selected for
        endovascular treatment by preoperative CT angiogram Patients with preoperative CT performed
        within 4 months of operation