Cloud-based fusion imaging found to improve operative metrics during FEVAR

Charles J. Bailey

A single-center retrospective review demonstrated a trend towards shorter operative times, and significant reductions in both iodinated contrast use and radiation exposure during fenestrated endovascular aneurysm repair (FEVAR) using Cydar’s EV Intelligent Maps—representing the first report of an improvement in metrics with the Zenith Fenestrated (ZFEN) graft while utilizing the fusion imaging system, according to the study authors.

“Intelligent map guidance improves the efficiency of complex endovascular aneurysm repair, providing a safer intervention for both patient and practitioner,” concluded Charles J. Bailey, MD, and colleagues from the University of South Florida and Tampa General Hospital in Tampa, Florida.

Results from the study were presented during the 2022 annual meeting of the Southern Association for Vascular Surgery (SAVS) held in Manalapan (Jan. 19–22). A retrospective review of a prospectively maintained aortic database was carried out to identify all patients who underwent commercially available FEVAR between 2013 and 2020, as well as all endovascular aneurysm repairs performed using the Cydar cloud-based fusion imaging platform at the institution starting from 2018.

Being solely focused on de novo FEVAR procedures, a comparative analysis was conducted on 53 FEVARs performed without EV Maps and 63 with the system. Cohorts were found to be similar in terms of patient demographics, medical comorbidities and aortic aneurysm characteristics. Bailey highlighted that body mass index was the same across both cohorts—”something to consider, as the larger the patient, the more radiation they will require.”

No significant difference in major adverse postoperative events, length of stay, or length of intensive care unit stay was noted between the groups, the research team found. Use of EV Maps resulted in non-significant decreases in mean fluoroscopy time (69.3 vs. 66.2 minutes, p=0.598), and a positive trend towards shorter operative times (204.4 vs. 186 minutes, p=0.278). Notably, a statistically significant decrease in both iodinated contrast volume (104.7 vs. 83.8ml, p=0.005), and patient radiation exposure via dose-area product (1049841 vs. 630990mGy/cm2, p<0.001) was observed in patients undergoing FEVAR with EV Intelligent Maps, the researchers reported.

Furthermore, Bailey pointed out the learning-curve element involved in use of the imaging platform, describing how the team took the relevant 63 patients and divided them into groups of 10. “After the 10th case, there was a significant and sustained reduction in radiation exposure,” he said.

Bailey told SAVS 2022: “This is a single center retrospective review. There is a learning curve to any novel technology. Maybe there is a bias to how much attention we pay to distance from operator … practitioner to radiation source, but it’s what we have embraced to do these complex procedures safely, both to us, and the patient and practitioners in the room. This is where we should be thinking with complex endovascular devices.”


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