Intraoperative computed tomography during fenestrated and branched endovascular aortic repair: a feasibility study

Background Endovascular aortic repair with fenestrated or branched endografts is technically challenging, and proper intraoperative assessment of all stent graft components with only angiography and fluoroscopy can be difficult. Intraoperative computed tomography (CT) imaging can be a valuable aid for the operators in the evaluation of stent grafting results prior to completion of surgery. Purpose To examine the feasibility of performing intraoperative CT imaging during fenestrated and branched endovascular aortic repair (f-bEVAR) under sterile conditions and with patients under general anesthesia. Material and Methods Intraoperative CT imaging was performed in 10 patients undergoing elective aortic repair with fenestrated or branched endografts. Adverse events, time consumption for CT set-up and image acquisition, and additional radiation dose to the patient were recorded. CT image quality was graded. Immediate corrective maneuvers performed based on the CT findings was registered. Results There were no adverse events related to intraoperative CT imaging. The median additional operating time by including intraoperative CT was 16 min (interquartile range [IQR] = 12-19), comprising 7% of the median total operating time. The median estimated additional radiation dose to the patient was 4.8 mSv (IQR = 3.8-4.9). All intraoperative CT examinations were considered to be of sufficient quality for stent graft evaluation. No immediate corrective procedures were performed on the basis of CT findings in this study cohort. Conclusion CT imaging intraoperatively during f-bEVAR is feasible with an acceptable increase in operating time and radiation dose.