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Plain cone-beam computed tomography during fenestrated endovascular aortic repair minimizes secondary interventions due to structural defects

Berczeli, Márton LU orcid ; Jirström, Wendela LU ; Mohammed, Yasir LU orcid ; Karelis, Angelos LU orcid ; Sonesson, Björn LU and Dias, Nuno V. LU orcid (2025) In Journal of Vascular Surgery
Abstract
Objectives
Structural defects during fenestrated endovascular aortic repair (FEVAR) can be difficult to identify only on two-dimensional imaging. This study aims to assess the potential additional value of routine intraoperative completion plain cone-beam computed tomography (CBCT) in identifying such defects during FEVAR.

Methods
A retrospective review of all consecutive FEVARs performed at a tertiary aortic center between January 2013 and December 2022. Patients with intraoperative plain CBCT and at least one postoperative CTA were selected. Baseline characteristics, operative data and follow-up data were collected. All imaging was re-reviewed for the purpose of the study. Endpoints included clinically significant... (More)
Objectives
Structural defects during fenestrated endovascular aortic repair (FEVAR) can be difficult to identify only on two-dimensional imaging. This study aims to assess the potential additional value of routine intraoperative completion plain cone-beam computed tomography (CBCT) in identifying such defects during FEVAR.

Methods
A retrospective review of all consecutive FEVARs performed at a tertiary aortic center between January 2013 and December 2022. Patients with intraoperative plain CBCT and at least one postoperative CTA were selected. Baseline characteristics, operative data and follow-up data were collected. All imaging was re-reviewed for the purpose of the study. Endpoints included clinically significant structural defects on CBCT and postoperative CTA and postoperative reinterventions. Data is presented as median and interquartile range (IQR) or number (%).

Results
Of the 271 patients treated with FEVAR during the study period, 234 were included in the analysis (197 male, 72 (68-77) years old, 219 (94%) elective repairs). A median of 4 (3-4) fenestrations were incorporated into the main body. Intraoperatively, 40 patients (17%) had a total of 45 clinically significant structural defects identified on CBCT, mostly related to target vessel bridging stents (n = 38). Postoperatively, 18 patients (8%) had 21 clinically significant structural defects, again mostly involving target vessels (n=8). Three of these were symptomatic, including one renal artery occlusion and two cases of lower limb claudication. Among the 18 patients with intraoperatively undiagnosed defects, retrospective re-review of the CBCT revealed that the findings had been visible in 11 (61%) cases. In five cases, image quality was insufficient, and in two cases, the defect was outside the CBCT field of view.

Conclusion
The routine use of intraoperative plain CBCT enabled the identification and immediate correction of more than two-thirds of all structural defects during FEVAR, but it remains challenging to completely eliminate secondary interventions due to structural defects. Further improvements can be expected with more detailed CBCT analysis and further improvements in imaging quality and increasing the field of view. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Vascular Surgery
publisher
Mosby-Elsevier
external identifiers
  • pmid:40812692
ISSN
1097-6809
DOI
10.1016/j.jvs.2025.08.006
language
English
LU publication?
yes
id
b07a61dd-f0b6-4154-9da5-aa6c9edb1c3f
alternative location
https://linkinghub.elsevier.com/retrieve/pii/S0741521425015988
date added to LUP
2025-08-15 18:39:41
date last changed
2025-08-18 08:42:19
@article{b07a61dd-f0b6-4154-9da5-aa6c9edb1c3f,
  abstract     = {{Objectives<br/>Structural defects during fenestrated endovascular aortic repair (FEVAR) can be difficult to identify only on two-dimensional imaging. This study aims to assess the potential additional value of routine intraoperative completion plain cone-beam computed tomography (CBCT) in identifying such defects during FEVAR.<br/><br/>Methods<br/>A retrospective review of all consecutive FEVARs performed at a tertiary aortic center between January 2013 and December 2022. Patients with intraoperative plain CBCT and at least one postoperative CTA were selected. Baseline characteristics, operative data and follow-up data were collected. All imaging was re-reviewed for the purpose of the study. Endpoints included clinically significant structural defects on CBCT and postoperative CTA and postoperative reinterventions. Data is presented as median and interquartile range (IQR) or number (%).<br/><br/>Results<br/>Of the 271 patients treated with FEVAR during the study period, 234 were included in the analysis (197 male, 72 (68-77) years old, 219 (94%) elective repairs). A median of 4 (3-4) fenestrations were incorporated into the main body. Intraoperatively, 40 patients (17%) had a total of 45 clinically significant structural defects identified on CBCT, mostly related to target vessel bridging stents (n = 38). Postoperatively, 18 patients (8%) had 21 clinically significant structural defects, again mostly involving target vessels (n=8). Three of these were symptomatic, including one renal artery occlusion and two cases of lower limb claudication. Among the 18 patients with intraoperatively undiagnosed defects, retrospective re-review of the CBCT revealed that the findings had been visible in 11 (61%) cases. In five cases, image quality was insufficient, and in two cases, the defect was outside the CBCT field of view.<br/><br/>Conclusion<br/>The routine use of intraoperative plain CBCT enabled the identification and immediate correction of more than two-thirds of all structural defects during FEVAR, but it remains challenging to completely eliminate secondary interventions due to structural defects. Further improvements can be expected with more detailed CBCT analysis and further improvements in imaging quality and increasing the field of view.}},
  author       = {{Berczeli, Márton and Jirström, Wendela and Mohammed, Yasir and Karelis, Angelos and Sonesson, Björn and Dias, Nuno V.}},
  issn         = {{1097-6809}},
  language     = {{eng}},
  month        = {{08}},
  publisher    = {{Mosby-Elsevier}},
  series       = {{Journal of Vascular Surgery}},
  title        = {{Plain cone-beam computed tomography during fenestrated endovascular aortic repair minimizes secondary interventions due to structural defects}},
  url          = {{http://dx.doi.org/10.1016/j.jvs.2025.08.006}},
  doi          = {{10.1016/j.jvs.2025.08.006}},
  year         = {{2025}},
}