Initial observations of endovascular aneurysm repair using Dyna-CT

Purpose: To examine the feasibility of a new technology that provides images resembling computed tomographic (CT) slices on the operating table during elective enclovascular abdominal aortic aneurysm (AAA) repair (EVAR). Technique: Commercially available Dyna-CT equipment was used in conjunction with Voxar 3D software for image reconstruction. During the preliminary evaluation of 9 patients (7 men; median age 73 years, range 67-84) with non-ruptured AAA undergoing elective EVAR with the Zenith Trifab stent-graft under regional anesthesia, the equipment functioned sufficiently well to produce the planned image clataset in 8 of 9 patients. Rotation failed in 1 overweight individual due to a short distance between the patient's abdomen and the C-arm. In 7 of 8 patients, the radiologist was able to measure the diameter of the aneurysm, and it was possible to visualize the entire length of the treated aorta and the iliac arteries in all cases. The proximal aortic neck, including the stent-graft, was visualized in 7 cases. No endoleak or other complications was detected, which was confirmed on the pre-discharge CT scans. The time interval from the rotation of the C-arm until the appearance on the monitor of the first automatically generated 3D images was 7 minutes, which has subsequently been reduced to -2 minutes. Conclusion: Our preliminary experience with Dyna-CT is promising, but further research is necessary to define the place of this imaging modality in EVAR.