Intraoperative cone beam computed tomography to improve outcomes after infra-renal endovascular aortic repair. - Université de Lille Accéder directement au contenu
Article Dans Une Revue J Vasc Surg Année : 2021

Intraoperative cone beam computed tomography to improve outcomes after infra-renal endovascular aortic repair.

Résumé

Objective We evaluated whether a combination of intraoperative contrast-enhanced cone beam computed tomography (ceCBCT) and postoperative contrast-enhanced ultrasound (CEUS) after infrarenal endovascular abdominal aortic aneurysm repair (EVAR) could reduce late stent graft–related complications and, consequently, reintervention. Methods All consecutive patients who had received infrarenal bifurcated stent grafts in our hybrid room (IGS 730; GE Healthcare, Île-de-France, France) during two discrete periods were included in the present study. From November 2012 to September 2013, two-dimensional completion angiography was performed after each EVAR, followed by computed tomography angiography (CTA) before discharge (group 1). From October 2013 to January 2015, intraoperative ceCBCT was performed, followed by CEUS within the first postoperative days (group 2). Comparative analyses of the outcomes were performed. The primary endpoint was late stent graft–related complications, a composite factor incorporating aneurysm-related death, type I or III endoleaks, kink or occlusion of the iliac limb, and aortic sac enlargement after the first 30 postoperative days. The secondary endpoint was all stent graft–related reinterventions. All-cause and aneurysm-related deaths were also recorded. Results Overall, 100 consecutive patients (50 each in groups 1 and 2) were enrolled, with a median follow-up of 60 months (interquartile range, 41-69 months). At 60 months after the index procedure, the freedom from late stent graft–related complications in each group was 61.6% (95% confidence interval [CI], 47.0%-80.6%) for group 1 and 81.7% (95% CI, 70.1%-95.2%) for group 2 (P = .033). The use of intraoperative ceCBCT was independently associated with a reduced rate of late stent graft–related complications on multivariate analysis (hazard ratio, 0.39; 95% CI, 0.16-0.95; P = .038) but did not appear to significantly protect against stent graft–related reinterventions (hazard ratio, 0.53; 95% CI, 0.20-1.39; P = .198) or all-cause death (P = .47). Conclusions To the best of our knowledge, the present study is the first to report the influence of routine ceCBCT on late outcomes after EVAR. The use of ceCBCT shows the potential for reducing late stent graft–related complications associated.

Dates et versions

hal-03999978 , version 1 (22-02-2023)

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Citer

Erol Lerisson, Benjamin O. Patterson, Adrien Hertault, Cédric Klein, Francois Pontana, et al.. Intraoperative cone beam computed tomography to improve outcomes after infra-renal endovascular aortic repair.. J Vasc Surg, 2021, Journal of vascular surgery, 75 (3), pp.1021-1029. ⟨10.1016/j.jvs.2021.08.057⟩. ⟨hal-03999978⟩
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