'Everything became very easy'

The EVAR Engine provides automated support before, during and after stent deployment

Thu Apr 14 00:00:00 CEST 2016

Repairing aortic aneurysms is precision work that requires unwavering concentration. With the EVAR Guidance Engine, Siemens Healthcare offers a solution for expanding surgical capabilities and improving clinical outcomes. The first automated workflow for stent deployment with fusion imaging aims to take the hassle out of all standard EVAR procedures.

At the 2016 Leipzig Interventional Course (LINC), Prof. Dr. Eric Verhoeven, Head of Vascular Surgery from Nuremberg Hospital, Dr. Giuseppe Panuccio, vascular surgeon from University Hospital Muenster and Dr. Philipp Geisbuesch, vascular surgeon from Heidelberg University, talked about their experiences with the technology.

 

CT data for fusion imaging prepared within minutes
With syngo EVAR Guidance1, all steps to prepare the CT dataset are automated for the first time. Based on the mesh modeling of the aortic wall, the EVAR Guidance Engine supports experts by providing automated segmentation of the aorta and side branch vessels. The ostia of all main vessels are automatically visualized, landing zones for the stent are proposed, and a possible optimum C-arm angulation for the procedure is calculated. This can lead to significant time savings and reduced workload. Giuseppe Panuccio particularly appreciated the significant time savings and reduced workload offered by the automation. He agrees, “Contrast agent is lower, radiation also. And, with only one click, you can find the precise position you need. What’s more, procedure accuracy increased, and the operator is more comfortable during the procedure.”
 

CT data for fusion imaging prepared within minutes
With syngo EVAR Guidance1, all steps to prepare the CT dataset are automated for the first time. Based on the mesh modeling of the aortic wall, the EVAR Guidance Engine supports experts by providing automated segmentation of the aorta and side branch vessels. The ostia of all main vessels are automatically visualized, landing zones for the stent are proposed, and a possible optimum C-arm angulation for the procedure is calculated. This can lead to significant time savings and reduced workload. Giuseppe Panuccio particularly appreciated the significant time savings and reduced workload offered by the automation. He agrees, “Contrast agent is lower, radiation also. And, with only one click, you can find the precise position you need. What’s more, procedure accuracy increased, and the operator is more comfortable during the procedure.”


Automated guidance during stent deployment
Fusion imaging provides surgeons with continuous guidance throughout the procedure. The optimal viewing projection for each side branch has already been calculated during preparation, and, after the target vessel is selected on the heads-up display, the C-arm can be moved easily to the calculated angulation, saving radiation dose and contrast for the patient.
Philipp Geisbuesch says: “It’s absolutely striking to see because it allows you constantly to have all the critical landmarks right in front of your eyes. You always know where the renal artery is, you always know the angulation that you have to choose. So the fusion imaging gives us the chance to exactly place the endograft in the correct angulation right on the spot. And we are using it with very low contrast.”
 

For peace of mind: immediate 3D assessment
Last but by no means least, surgeons can assess results right away – using intra-operative 3D imaging with syngo DynaCT. Image acquisition in lateral or head side position is completed in only five seconds to discover associated complications with the endograft right in the OR while the patient is still on the table. Eric Verhoeven recognizes another advantage of doing a syngo DynaCT acquisition at the end of the procedure. His team in Nuremberg, Germany has long been offering individually tailored follow-up to patients. “We now can add syngo DynaCT to our algorithm to determine how soon we need to see our patients for follow-up.” He also points out that the technology itself has taken a step forward: “The new application is much easier to use, with the automated registrations of the aorta and target vessels, and with manual corrections possible during the procedure. These small changes are so important in practice. There is no doubt that, for EVAR procedures, today’s version of this fusion technology already offers a huge advantage.”
 

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1Under FDA Review. Not available for sale in the U.S. The product/information mentioned here is not commercially available in the US or in other countries. Due to regulatory reasons, its future availability cannot be guaranteed.