Fusion imaging makes it possible to improve endovascular procedures and is mainly used in hybrid rooms for aortic procedures. The objective of this study was to evaluate the feasibility of fusion imaging for femoro-popliteal endovascular procedures with a mobile flat plane sensor and dedicated software to assist endovascular navigation.
Between May and December 2017, 41 patients requiring femoro-popliteal endovascular revascularization were included. Interventions were carried out in a conventional surgical room equipped with a mobile plane sensor (Cios Alpha, Siemens). The numerical video stream was transmitted to an angionavigation station (EndoNaut (EN), Therenva). The software created an osseous and arterial panorama of the treated limb from the angiographies carried out at the beginning of procedure. After each displacement of the table, the software relocated the current image on the osseous panorama, with 2D-2D resetting, and amalgamated the mask of the arterial panorama. The success rates of creation of osseous and arterial panorama and the success of relocation were evaluated. The data concerning irradiation, the volume of contrast injected, and operative times were recorded.
Osseous panoramas could be automatically generated for the 41 procedures, without manual adjustment in 33 cases (80.5%). 35 relocations based on a 2D-2D resetting could be obtained in the 41 procedures, with a success rate of 85%. The causes of failure were a change in table height or arch angulation. The average duration of intervention was 74.5 min. The irradiation parameters were: duration of fluoroscopy 17.8 ± 13.1 min, K 80.5 ± 68.4 mGy, DAP 2140±1599 μGy.m. The average volume of contrast (VC) was 24.5 ± 14 mL.
This preliminary study showed that fusion imaging is possible in a non-hybrid room for peripheral procedures. Imagery of mobile C-arms can be improved for femoro-popliteal endovascular procedures without heavy equipment. These imagery tools bring an operative comfort and could probably reduce irradiation and the injected volume of contrast. The clinical benefit must be evaluated in more patients in a randomized comparative study with a rigorous methodology.

Copyright © 2020. Published by Elsevier Inc.