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REVIEW  RECENT DEVELOPMENTS IN THE MANAGEMENT OF PARARENAL AND TAAAS 

The Journal of Cardiovascular Surgery 2019 February;60(1):41-53

DOI: 10.23736/S0021-9509.18.10673-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Optimizing imaging and reducing radiation exposure during complex aortic endovascular procedures

Vincenzo VENTO 1, 2, Raphael SOLER 1, Dominique FABRE 1, Laurence GAVIT 3, Emmanuelle MAJUS 3, Philippe BRENOT 1, Mauro GARGIULO 2, Stéphan HAULON 1

1 Aortic Center, Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; 2 Division of Vascular Surgery, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi Polyclinic, Bologna, Italy; 3 GE Healthcare, Buc, France



Improvements in endovascular technologies and development of custom-made fenestrated and branched endografts currently allow clinicians to treat complex aortic lesions such as thoraco-abdominal and aortic arch aneurysms once treatable with open repair only. These advances are leading to an increase in the complexity of endovascular procedures which can cause long operation times and high levels of radiation exposure. This in turn places pressure on the vascular surgery community to display more superior interventional skills and radiological practices. Advanced imaging technology in this context represents a strong pillar in the treatment toolbox for delivering the best care at the lowest risk level. Delivering the best patient care while managing the radiation and iodine contrast media risks, especially in frail and renal impaired populations, is the challenge aortic surgeons are facing. Modern hybrid rooms are equipped with a wide range of new imaging applications such as fusion imaging and cone-beam computed tomography (CBCT). If these technologies contribute to reducing radiation, they can be complex and intimidating to master. The aim of this review is to discuss the fundamentals of good radiological practices and to describe the various imaging tools available to the aortic surgeon, both those available today and those we anticipate will be available in the near future, from equipment to software, to perform safe and efficient complex endovascular procedures.


KEY WORDS: Operating rooms - Radiation exposure - Electromagnetic radiation - Thoracic aortic aneurysm - Abdominal aortic aneurysm - Vascular grafting

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