AAA , use of hybrid room to advance surgical treatment

Question 1

Name risk factors associated with AAA.

Answer 1

• Genetics
• Smoking
• Age
• Blood pressure

Question 2

How long does a patient need to be admitted to the hospital after AAA repair via:
- open surgery
- EVAR

Answer 2

• open surgery → 7 days
• EVAR → 2 days

Question 3

Fill in the right percentage.

The reintervention rate of EVAR after 12 years is …%.

Answer 3

40%

Question 4

The biggest problem of EVAR is endoleak, with a high prevalence of 20-40% for type II endoleak. What is a type II endoleak?

Answer 4

Retrograde flow into the aneurysm sac from aortic side-brances such as he lumbar or inferior mesenteric arteries.

Question 5

What 3 steps are important for 3D stent placement?

Answer 5

1. 3D reconstruction
2. Central-lumen line
3. Stent graft plan

Question 6

For 3D EVAR stent placement, what measurements are important to calculate?

Answer 6

• The inner-to-inner diameter
• The outer-to-outer diameter

Question 7

For the planning of EVAR surgery and the surgery itself, besides a CT-scanner, a C-arm can be used. What is the advantage of using a C-arm for this type of surgery?

Answer 7

• Lower patient dose and increased image quality.

Question 8

What is digital subtraction angiography (DSA)?

Answer 8

Fluoroscopy technique used to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a “pre-contrast image” or mask from subsequent images, once the contrast medium has been introduced into a structure.

Question 9

For digital subtraction angiography (DSA), an iodine-based contrast agent is used to visualize the blood vessels. What is the downside to the use of this contrast agent?

Answer 9

It is nephrotoxic (toxic for the kidneys)

Question 10

What is the definition of the deterministic and stochastic risks regarding X-ray radiation?

Answer 10

• Deterministic → short term, threshold dose
• Stochastic → long term, damage to DNA, latency time

Question 11

What are As Low As Reasonably Achievable (ALARA) radiation reduction strategies?

Answer 11

• Collimination
• Low fluoroscopy protocol
• Minimize the air gap between X-ray source and detector
• Lead shielding
• Take distance

Question 12

What is meant with image fusion (on the hybrid OR)?

Answer 12

A novel tool for 3D roadmapping which reduces radiation exposure and contrast agent dose in complex endovascular intervention. It does this by combining the preoperative CTA image with the fluoroscopy image.

Question 13

Name things that are reduced due to the use of image fusion.

Answer 13

• Radiation dose
• Fluoroscopy time
• Contrast volume
• Procedure time

Question 14

What lies in the future for hybrid OR?

Answer 14

• Augmented reality
• Artificial intelligence algorithms
• Radiation free procedures
• Improvement of patient outcomes

Question 15