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Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone  Ann H. Kim, MD, Daniel.

Published byRosalind Mosley Modified over 6 years ago

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Presentation on theme: "Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone  Ann H. Kim, MD, Daniel."— Presentation transcript:

1 Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone  Ann H. Kim, MD, Daniel E. Kendrick, MD, Pamela A. Moorehead, MS, Anil Nagavalli, MS, Claire P. Miller, MS, Nathaniel T. Liu, MD, FACS, John C. Wang, MD, FACS, Vikram S. Kashyap, MD, FACS  Journal of Vascular Surgery  Volume 64, Issue 1, Pages (July 2016) DOI: /j.jvs Copyright © 2016 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Patient-specific case as seen on the endovascular aneurysm repair (EVAR) simulator: (A) Aortography obtained using a marker pigtail catheter and (B) constrained infrarenal system before deployment. C, Patient-specific case with high neck angulation and a suprarenal system. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Ideal seal zone by the proximal portion of the stent was estimated by calculating the surface area (SA) of an oblique cylinder. L1 refers to the distance from the lowest renal artery (a) to the aneurysm neck. L2 refers to the distance from b to the aneurysm neck. C, Circumference of the aortic neck as calculated from computed tomography (CT) scan. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

4 Fig 3 A, Example of a three-dimensional reconstruction generated by the Simbionix (Cleveland, Ohio) endovascular aneurysm repair (EVAR) module. B, Measurements were taken using AutoCAD software (Autodesk, San Rafael, Calif). Actual seal zone coverage by the final deployed stent graft was determined by subtracting any surface area not covered by the stent from the ideal seal zone. (A and B are different simulations.) Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

5 Fig 4 When the first 10 and last 10 cases were compared, a 33% overall reduction in (left) mean procedure time was observed among the six participants, 311.5 ± 11.3 vs 206.3 ± 7.6 seconds (P < .0001). Right, A 50% reduction in fluoroscopy time was also noted, 158.2 ± 7.9 vs 81.4 ± 4.8 seconds (P < .0001). The error bars show the standard error of the mean. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

6 Fig 5 A, Procedure time and (B) fluoroscopic time are shown for all participants over the course of the study. This highlights the early and steep learning curve, which plateaued for all participants. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

7 Fig 6 One-way analysis of variance of mean percentage of seal zone coverage for each deployment handle is shown stratified by degree of infrarenal angulation. The error bars show the standard error of the mean. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

8 Fig 7 In abdominal aortic aneurysm (AAA) cases where the infrarenal neck angle measured >40°, the participants in the novice group had higher number of cases with stent graft placement graded as “unacceptable” than the experts group. The failure rate was 34% vs 15% (P = .01). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

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