Intra-operative DynaCT improves technical success of endovascular repair of XXXX .

@entity1 @entity63 @entity439 @entity715 @entity1028
OBJECTIVES: To evaluate feasibility, technical success, and the need for reintervention in the early perioperative period, following the introduction of intraoperative DynaCT (DynaCT, Siemens AG, Berlin, Germany) in @entity1 undergoing @entity439 repair (EVAR). DynaCT involves the generation of computed tomography (CT)-like images from "on table" rotational angiographic acquisition. METHODS: A prospectively maintained database of 312 @entity1 undergoing EVAR (September 2001 - February 2007) was interrogated to determine incidence of early reintervention following satisfactory appearances of uniplanar completion angiography (control group). Following the introduction of DynaCT (DynaCT group - 80 @entity1 ), clinical and radiologic outcomes were prospectively evaluated (September 2007 - May 2008). Both groups underwent pre-discharge computed tomographic angiography (CTA) and color-flow duplex scan. Comparative analysis of procedural data, hospital-stay, mortality, and early reintervention between the two groups was undertaken. RESULTS: In the control group, 14 (4.5%) @entity1 required reintervention procedures within 30 days of EVAR (10 endovascular, 7 surgical). Six @entity1 had type 1 endoleaks and 8 presented with @entity63 . Review of this cohort suggested that the majority of complications (86%) may have been immediately identifiable with improved intra-operative quality control. In the DynaCT group, DynaCT was feasible in 81.3% (n = 65/80) of @entity1 and resulted in the detection of five clinically significant anomalies (6.25%, n = 5/80). These technical problems were not identified at completion angiography but were corrected after DynaCT (2 type 1 endoleaks, 1 type 3 endoleak, 1 limb compression, and 1 graft @entity715 ). Standard pre-discharge imaging did not identify any further graft-related complications in the DynaCT group. Introduction of DynaCT resulted in a reduced need for early reintervention (0/80 vs 14/312, P = .05). CONCLUSION: Most graft-related complications that mandate early reintervention following EVAR are due to remediable technical problems which are not identified by uniplanar completion angiography alone. DynaCT is a feasible intra-operative adjunct to completion angiography, which improves intra-operative quality control during endovascular repair of @entity1028 .
