Tomographic methods in endovascular aortoiliac treatment

Detta är en avhandling från Unit for Clinical Vascular Disease Research

Sammanfattning: Endovascular treatment had developed rapidly and the procedures have increased in complexity. The demand of imaging excellence is imperative to perform these interventions. However both pre and postoperative investigations are performed by the use of advanced three-dimensional imaging, while the treatment itself relies on two-dimensional imaging. With the use of Cone Beam Computed Tomography (CBCT) this drawback is abolished. This thesis will try to elucidate the clinical effect of this tomographic method in the endovascular treatment of aortailiac vascular disease. The specific aim of this thesis was to evaluate: 1. To evaluate the postoperative Computer Tomography Angiography assessment made by vascular surgeons and interventional radiologists after Endovascular Aortic Repair at a tertiary vascular clinic. 2. To evaluate if Cone Beam Computed Tomography can detect intraoperative complications in comparison with Computer Tomography Angiography follow up. 3. To quantify the radiation dose from CBCT in comparison to conventional CTA used for EVAR follow up. 4. Investigate the role of CBCT in the treatment of aortoiliac occlusive disease in order to optimize the primary operation results. This thesis showed that CBCT is an excellent technique to evaluate the configuration of stents and stentgrafts in the aortoiliac segment. CBCT rendered additional adjunctive procedures that were not detected by conventional imaging technique in the intraoperative setting. However there are limitations with the technique such as the considerable amount of radiation it adds to the procedures and the inability to detect type II endoleaks during EVAR and the use of contrast enhancement is questionable. CBCT facilitates improved intraoperative results in standard EVAR operations and aortoiliac operations. There is a need for further studies to validate long-term results.