Fusion Imaging Reduces Radiation and Contrast Medium Exposure During Endovascular Revascularization of Iliac Steno-Occlusive Disease

Introduction: To evaluate feasibility, safety and efficacy of fusion imaging in order to guide endovascular revascularization of iliac steno-occlusive disease. 

Materials and Methods: Retrospectively, we identified twenty-six patients (20 male, mean age 63 ± 8y; Rutherford II-V) who underwent revascularization of a chronic total occlusion (n = 6; 23%) or severe stenosis (n = 20; 77%) of the common and/or external iliac artery. Median lesion length was 33 mm (IQR 20–60). In one group of patients (NEW; n = 11), fusion imaging with 2-D/3-D registration was used to guide revascularization. No baseline digital subtraction angiography (DSA) had been acquired in these patients. In another group of patients (OLD; n = 15), no fusion imaging had been utilized and at least one DSA run had been performed to guide the procedure. In both groups, final DSA of the treated lesions was performed. Number of DSA runs, radiation and contrast medium exposure, technical success (residual stenosis < 30%) and complications were analyzed. 

Results: Median DSA runs needed in OLD for guidance were n = 2 (IQR 2–3) and in NEW n = 0 (IQR 0–0; p = 0.001). Compared to OLD, median dose area product (DAP) was reduced by 17,118 mGy*cm² (IQR 10,407–23,614; p = 0.016) if fusion imaging guidance had been used (NEW). Based on the median DAP of the final angiogram in NEW, median DAP reduction was 6007 mGy*cm² (IQR 5012–16,105; p = 0.1). Median total contrast medium volume injected in NEW was 45 ml (IQR 30–90) and in OLD 120 ml (IQR 100–140; p = 0.001). Technical success was 100% for both groups. In 1/27 patients (3.7%) a minor complication (embolism) occurred. 

Conclusion: Fusion imaging proved to be feasible as well as safe and significantly reduces radiation and contrast medium exposure during endovascular revascularization of iliac steno-occlusive disease.