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Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance

Truijers, M.; Resch, Tim LU ; Van den Berg, J. C.; Blankensteijn, J. D. and Lonn, I. (2009) In Journal of Cardiovascular Surgery 50(4). p.423-438
Abstract
Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance. Today most interventionists and surgeons will rely on CT or MR to assess aortic morphology, evaluate access artery patency and locate side branch orifices. However, recent developments in cross-sectional imaging, including advanced image postprocessing,... (More)
Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance. Today most interventionists and surgeons will rely on CT or MR to assess aortic morphology, evaluate access artery patency and locate side branch orifices. However, recent developments in cross-sectional imaging, including advanced image postprocessing, multi-modality image fusion and new contrast agents have resulted in improved spatial resolution for preoperative planning. Advanced reconstruction algorithms, like dynamic CTA and MRA, provide valuable information on dynamic changes in aneurysm morphology that might have an important impact on endograft selection. During follow-up, imaging of the graft and aneurysm is of utmost importance to identify patients in need of secondary intervention. This has led to rigorous follow-up protocols including duplex ultrasound and regular CT examinations. The use of these intense follow-up protocols has recently been questioned because of high radiation dose and the frequent use of nephrotoxic contrast agents. New imaging modalities like contrast enhanced DUS, dynamic MR and dual-source CT could reduce radiation dose and obviate the need for nephrotoxic contrast. Up-to-date knowledge of non-invasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Tomography, trends, Vascular surgical procedures, therapy, Aneurysm, Diagnostic imaging, X-ray computed, Magnetic resonance imaging, Ultrasonography
in
Journal of Cardiovascular Surgery
volume
50
issue
4
pages
423 - 438
publisher
Edizioni Minerva Medica
external identifiers
  • wos:000271955000002
  • scopus:70450204612
ISSN
0021-9509
language
English
LU publication?
yes
id
8af2562b-2da5-4d6a-80af-e4ed2da5ea17 (old id 1518326)
date added to LUP
2010-01-04 13:14:19
date last changed
2017-02-26 03:47:53
@article{8af2562b-2da5-4d6a-80af-e4ed2da5ea17,
  abstract     = {Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance. Today most interventionists and surgeons will rely on CT or MR to assess aortic morphology, evaluate access artery patency and locate side branch orifices. However, recent developments in cross-sectional imaging, including advanced image postprocessing, multi-modality image fusion and new contrast agents have resulted in improved spatial resolution for preoperative planning. Advanced reconstruction algorithms, like dynamic CTA and MRA, provide valuable information on dynamic changes in aneurysm morphology that might have an important impact on endograft selection. During follow-up, imaging of the graft and aneurysm is of utmost importance to identify patients in need of secondary intervention. This has led to rigorous follow-up protocols including duplex ultrasound and regular CT examinations. The use of these intense follow-up protocols has recently been questioned because of high radiation dose and the frequent use of nephrotoxic contrast agents. New imaging modalities like contrast enhanced DUS, dynamic MR and dual-source CT could reduce radiation dose and obviate the need for nephrotoxic contrast. Up-to-date knowledge of non-invasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects.},
  author       = {Truijers, M. and Resch, Tim and Van den Berg, J. C. and Blankensteijn, J. D. and Lonn, I.},
  issn         = {0021-9509},
  keyword      = {Tomography,trends,Vascular surgical procedures,therapy,Aneurysm,Diagnostic imaging,X-ray computed,Magnetic resonance imaging,Ultrasonography},
  language     = {eng},
  number       = {4},
  pages        = {423--438},
  publisher    = {Edizioni Minerva Medica},
  series       = {Journal of Cardiovascular Surgery},
  title        = {Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance},
  volume       = {50},
  year         = {2009},
}