Approximately one-third1 of patients who undergo endovascular repair of abdominal aortic aneurysms (EVAR) will have an endoleak, a condition in which blood flows outside the lumen of the endograft but within the aneurysm sac, potentially increasing the risk of rupture. Type II endoleaks, in which aortic branches that have been excluded by an endograft perfuse the aneurysm sac, are the most common endoleak and can have multiple feeding and draining vessels that make their treatment challenging.
More precise and more efficient procedures
Siemens syngo® iGuide integrated needle guidance enables physicians to perform needle procedures such as Type II endoleak repairs more precisely and efficiently using the Artis zee® family of C-arm systems. Since the planning of the procedure is done within the angio suite, the software solution frees up the hospital’s computed tomography (CT) scanners for routine diagnostic imaging and enhances workflow by eliminating the need to transfer the patient during the procedure.
“The most important thing for us is that the aneurysm stops growing,” says Alan Lumsden, MD, Medical Director of the Methodist Hospital DeBakey Heart and Vascular Center in Houston, Texas, USA, and Professor of Cardiovascular Surgery at Weill Cornell Medical College of Cornell University, Ithaca, New York, USA. “And, in the majority of patients that we have treated with syngo iGuide, the aneurysm has stopped growing and the endoleak has gone away.”.
Handling challenging cases with ease
Interventional radiologist David Lacey, MD, at Iowa Methodist Medical Center in Des Moines, Iowa, USA, says several components of syngo iGuide reflect a level of refinement not seen in similar needle guidance systems. The ability to obtain a control scan after the needle has been placed helps ensure accuracy by automatically correcting patient motion or the deformation of tissues caused by the pressure of the needle on the skin. The Artis zee ceiling-mounted system Lacey uses is equipped with an integrated laser crosshair that precisely marks the skin entry point. This reduces radiation dose by eliminating the need for fluoroscopy to match the needle tip with the path in the bull’s-eye view and improves ease-of-use.
The physician says the power of the technology is evident by the ease with which it handles challenging cases, such as aneurysm sacs that measure less than a centimeter. “I’m always impressed that I can hit that target, often in just one pass, using this system,” Lacey says.
· syngoDynaCT images eliminate need to transfer the patient to a CT scanner, enhancing workflow
· Precise needle placements can reduce time needed to perform the procedure, particularly when small vessels are involved
· Radiologists can enter the aneurysm sac at a location that maximizes likelihood of embolizing vessels feeding the endoleak
· Needle path planning can be performed on DynaCT, CT or MR images
· Using the optional laser cross hair reduces radiation and time, and enhances precision
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Baum RA, et. al. Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms J Vasc Inerv Radiol 2003; 14:1111-1117.