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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2015 Jul 14

lingua: Inglese

Validation of pre-procedural aortic aneurysm volume calculations to estimate procedural fill volume of endobags in endovascular aortic sealing

Boersen J. T. 1, 2, van den Ham L. H. 3, Heyligers J. M. 4, Vahl A. C. 5, Vriens P. W. 4, Reijnen M. M. 3, de Vries J. P. 1

1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands;
2 Department of Technical Medicine, University of Twente, Enschede, The Netherlands;
3 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands;
4 Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands;
5 Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands


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OBJECTIVE: Endovascular aortic sealing (EVAS) with a sac anchoring endoprosthesis excludes abdominal aortic aneurysms based on polymer filling of endobags. Primary objective was to assess the reliability of pre-procedural computed tomography (CT) scans based calculations of required endobag volume in relation to intraoperative volume of the endobags.
METHODS: Forty elective EVAS patients were included. Pre-procedural estimations of endobag volume were based on CT segmentations of aortic flow lumen volume, including both automated and manually adjusted segmentations, performed by two experienced users. Additionally, changes in maximum AAA diameter, thrombus volume and total AAA volume were calculated from pre- and post-procedural CT scans.
RESULTS: Automatically determined volumes were comparable to manually adjusted calculations (75.3 mL vs 75.7 mL) and inter-observer agreement regarding pre-EVAS calculations of prefill volume appeared almost perfect with an intraclass correlation coefficient of 0.98 (95 % CI: 0.96 – 0.99). The mean pressure of the endobags was 185 mm Hg. Manually adjusted pre-procedural volume calculations underestimated procedural volume of the endobags (-11.3 mL ± 9.9 mL). Differences between pre-EVAS and procedural volume measurements were independent from endobag pressure (R=-0.06, P=0.72), prepocedural thrombus volume (R=-0.303, P=0.057) and changes in total AAA volume (R=0.02, P=0.91). A significant association was determined between differences in pre-EVAS and endobag volume versus changes in thrombus volume pre- and post-procedural (R=0.39, P=0.01).
CONCLUSIONS: In this validation study pre-procedural volume measurements underestimate the actual fill volume of the endobags. It should be advised to perform a prefill of the endobags during the EVAS procedure.

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j.boersen@antoniusziekenhuis.nl