EndoNaut 2D Fusion-imaging with a Mobile C-Arm for endovascular treatment of occlusive peripheral arterial disease.

Abstract

INTRODUCTION\nEndovascular treatment has become the first-line strategy for peripheral arterial disease (PAD). Given the number of procedures, any technology associated with a reduction in radiation exposure and contrast volume is highly relevant. This study aimed to evaluate whether 2D fusion imaging (FI) could reduce the radiation exposure and contrast volume during endovascular treatment of occlusive PAD.\n\n\nMETHODS\nThis consecutive, retrospective, single-center, non-randomized comparative trial included patients with PAD at the femoral, popliteal, and/or tibial level, at any clinical stage, if they were candidates for endovascular revascularization. Patients were treated with or without the EndoNaut 2D FI system (Therenva, Rennes, France) in a non-hybrid room with the same Cios Alpha mobile C-arm (Siemens, Munich, Germany). Indirect dose area product (DAP) and contrast medium volume were recorded.\n\n\nRESULTS\nBetween March 2018 and April 2020, 255 patients underwent endovascular femoropopliteal revascularization with (n =124) or without (n =131) 2D FI. The volume of injected contrast medium (34.7 ± 13.8 mL v 51.3 ± 26.7 mL in the control group; p<0.001) and DAP (8.9 ± 9.9 Gy/cm2 v 13.5 ± 14.0 Gy/cm2 in the control group; p=0.003) were significantly lower for the 2D FI group. Subgroup analysis of complex (TASC C/D) lesions showed similar results. Stratification of the FI group into three sub-groups, according to procedure dates, showed no effect of a potential learning curve on operative parameters.\n\n\nCONCLUSION\nThis study shows a significant reduction in contrast and radiation dose for endovascular treatment of PAD when applying the 2D FI technology. Overall, a reduction of more than 30% is observed for both operative parameters, without excessive training requirements, highlighting the potential benefits of using 2D FI daily when performing endovascular revascularization for PAD.