Fusion imaging guidance for endovascular recanalization of peripheral occlusive disease.

Abstract

INTRODUCTION\nEndovascular procedures are now the first line option for treatment of lower extremity arterial disease (LEAD). Fusion imaging guidance has been reported to reduce radiation exposure and reintervention rates during fenestrated and branched endovascular repairs (F-BEVAR) but limited literature exists on its benefits during LEAD endovascular procedures, and more specifically peripheral occlusive disease (POD). This study aims to evaluate the radiation exposure and technical success benefits of fusion imaging guidance in a large cohort of patients treated endovascularly for complex POD.\n\n\nMATERIAL AND METHODS\nFrom January 2017 to September 2019, in a single center, all consecutive patients presenting symptomatic occlusions (Rutherford Baker categories 3 to 6) in the setting of POD and treated endovascularly were retrospectively assessed for inclusion. All procedures were performed under augmented fluoroscopy guidance (Vessel ASSIST, GE Healthcare) overlaying on live imaging the 3D path for transluminal recanalization based on the pre-operative CTA. Technical success, dose area product (DAP), total cumulated air kerma (CAK) and fluoroscopy time were collected. DAP results were compared to the literature.\n\n\nRESULTS\nDuring the study period, 179 patients were treated for iliac (n=56) or femoropopliteal (n=123) symptomatic arterial occlusions. Technical success was reported in 171/179 procedures (95.5 %). The use of a re-entry catheter was required to achieve technical success in 11 patients (6.1%). Mean DAP and CAK were 15.44 Gy.cm2 and 135mGy, respectively, with a mean fluoroscopy time of 15.04min. DAP and CAK were significantly higher in the iliac group when compared to the femoropopliteal group though fluoroscopy time was not significantly different. DAP was lower than levels reported in the literature.\n\n\nCONCLUSION\nRoutine use of fusion imaging guidance during POD endovascular treatment is associated with low radiation exposure, high technical success and reduced need for re-entry systems.