Search

Purpose: To report the benefits and the role of carbon dioxide (CO 2 ) angiography in case of misalignment between fenestration and target vessel during fenestrated endovascular aneurysm repair (F-EVAR)., Technique: During F-EVAR, misalignment between fenestration and target vessel is a potentially catastrophic complication. In 2 patients, we experienced that one of the target vessels were not visible during standard angiography in different projections after positioning a fenestrated graft and even after cannulation of the corresponding fenestration. In both cases, the graft was sealed to the aortic wall but not in the predictable position. Consequently, acute occlusion of the target vessel was hypothesized. However, CO 2 angiography was useful to evaluate patency of the target vessel clarifying the relative position of the fenestration versus the target vessel. Rescue maneuvers were feasible under the guidance of CO 2 angiography in order to obtain the cannulation of both renal arteries. In both cases, the procedure was successfully accomplished., Conclusion: In case of misalignment of a fenestration during F-EVAR and non-visualization of the target vessel with standard angiography, CO 2 angiography could have the unique and complementary role of clarifying the patency and position of the target vessel. In addition, CO 2 could guide the rescue maneuvers.

Objectives: Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished., Methods: Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (P KA ), total air kerma at the reference point (K a,r ), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender., Results: The mean values for each site A, B, C, D, and E were: P KA s of 4343 ± 994 μGym 2 , 18,200 ± 2141 μGym 2 , 11,423 ± 1390 μGym 2 , 7796 ± 704 μGym 2 , 31,897 ± 5798 μGym 2 ; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile P KA was 15,849 μGym 2 ., Conclusion: Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures., Key Points: • Abdominal endovascular aneurysm repair (EVAR) requires the use of ionising radiation. • EVAR is a minimally invasive procedure for the treatment of abdominal aortic aneurysms. • Diagnostic reference levels (DRLs) are used to monitor patient radiation exposure. • Radiation dose data was collected from five European centres for EVAR procedures. • Local DRLs have been determined and an interim European DRL is proposed.

The aim of this study was to assess the patient dosimetric impact of endovascular abdominal aortic aneurysm repair (EVAR), both in an operating theatre (OR) and in an angiosuite (AS), with the facility of Dynamic CT (Dyna CT, Siemens AG, Berlin, Germany). One hundred and forty-six consecutive EVAR procedures dating from May 2011 to March 2013 were analysed. These were performed either in an OR (n = 97) using a mobile C-arm or in an AS (n = 49) equipped with a ceiling-mounted angiography system. Air kerma area product (P(KA)) and total air kerma at reference point (K(a,r)) values were reported for all procedures and Dyna CT. Radiation exposure during EVAR was quite low in the majority of patients but nearly 50 % higher if performed in AS vs. OR. Median Dyna CT K(a,r) was the same as an entire EVAR procedure in OR. The higher patient's radiation exposure recorded in the AS should be balanced with the technical advantages given to the EVAR procedure., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)