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Ticketed Event
Ticketed Event

Poster Competition

(PC236) Impact of Cone Beam Computed Tomography Assessment on Intra-operative Detection of Technical Defects and Early Secondary Interventions Following Fenestrated-Branched Endovascular Aortic Repair

Friday, June 6, 2025
12:30 PM - 2:00 PM CT

    Submitting & Presenting Author(s)

  • DB

    Dora Babocs

    • Co-Author(s)

  • ET

    Emanuel R. R. Tenorio

    Postdoctoral Research Fellow
    The University of Texas Health Science Center at Houston
    Houston, Texas

  • Bruno P. Schmid, MD (he/him/his)

    Research fellow, Advanced Endovascular Aortic Research Program.
    Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston
    houston, Texas

  • Lucas R. Kanamori, MD

    Postdoctoral Research Fellow
    Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
    Houston, Texas

  • AV

    Alexander Vanmaele

  • SM

    Steven Maximus

  • Bernardo C. Mendes, MD

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • NS

    Naveed U. Saqib

    Associate Professor
    Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
    Houston, Texas

  • HL

    Heidi Lane

  • YH

    Ying Huang

    Assistant Director, Advanced Endovascular Aortic Research Program.
    Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston
    Houston, Texas

    • Senior Author(s)

  • Gustavo S. Oderich, MD

    Vascular Surgeon, Professor of Surgery
    Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston
    Houston, Texas

Objectives: To evaluate the impact of intra-operative assessment using Cone Beam Computed Tomography (IO-CBCT) on detection of intra-operative findinds (IOF) and early secondary interventions (SI) among patients treated for complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAAs) using fenestrated-branched endovascular aortic repair (FB-EVAR).

Methods: The clinical data from consecutive patients treated by a single operating team in two institutions using FB-EVAR was reviewed (2007-2024). IO-CBCT was used routinely since 2012. Standard cumulative sum (CUSUM) analysis was used to describe the incidence of IOFs (stent kink, infolding, vessel occlusion, dissection, thrombus or endoleak) and any aortic or branch-related SI within the first 30-days or within hospital stay.

Results: There were 860 patients (71.7% male, mean age 73.78.39 years-old) treated by FB-EVAR, including for 310 patients (36%) with CAAAs and 550 (64%) with TAAAs. A total of 3,159 renal-mesenteric arteries were incorporated by fenestrations or branches with mean of 3.670.78 vessels/patient. Patients who had FB-EVAR with IO-CBCT assessment had higher proportion of TAAAs (72.6% vs. 40.6%, P< 0.001), chronic dissections (13.7% v 3.3%, P< 0.001) and had more vessels incorporated per patient (3.810.63 vs 3.420.93, P< 0.001). Although there was no difference in the incidence of early SIs in patients with or without IO-CBCT assessment (7.9% v 9.6%, P=0.494), including aortic (1.4% v 1.7%, P=1.0) and branch-related SIs (5.8.% v 7.5%, P=0.434), CUSUM analysis (Figure 1) demonstrated that routine IO-CBCT was associated with increased detection of any IOFs (CUSUM score; -7.0 to +74.0), which coincided with a decline in the cumulative composition of any SIs (+2 to -14), primarily due to a decrease in minor SIs (+2 to -11), but not in major SIs (0 to -3).

Conclusions: Despite the increasing complexity in aneurysm extent and endovascular repairs, incidence of early SIs remained stable in the last decade of experience with routine utilization of IO-CBCT. Nonetheless, routine use of IO-CBCT effectively detected IOFs and reduced the rate of minor SIs over time.