Retrospective Comparison of Stiff Wire-Based 2D3D, Traditional 3D3D Image Fusion, and Non-Image Fusion Techniques and Their Role in Thoracic Aortic Endovascular Repair

Objective: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. Methods: A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included. The dose area product and number of DSAs were considered as primary outcomes, while projection accuracy and image fusion accuracy were considered as secondary outcomes. Results: A total of 79 patient were included. They were allocated to non-image fusion (NIF, n = 40), 2D3D IF (n = 14), and 3D3D IF (n = 25) groups. DAP was significantly lower both in the NIF [1542.75 mu Gym2 (751.72-3351.25 mu Gym2), p = 0.011] and 2D3D IF [1320.1 mu Gym2 (858.57-2572.07 mu Gym2), p = 0.013 groups compared to the 3D3D [2758.61 mu Gym2 (2074.73-4772.9 mu Gym2)] cohort. In the Z3 subgroup, DAP was significantly lower in the 2D3D IF group compared to the 3D3D IF group [(1270.84 mu Gym2 (860.56-2144.69 mu Gym2) vs. 2735.76 mu Gym2 (1583.86-5077.23 mu Gym2), p = 0.044]. 2D3D image fusion was associated with a significantly lower number of pre-deployment angiographies compared to NIF [1 (1-1) vs. 2 (1-3), p = 0.031], which we used as a surrogate for contrast dose. Conclusions: The entire study population analysis showed a significantly lower DAP with 2D3D IF compared to 3D3D IF, while there was no significant difference compared to NIF. It seems that stiff wire-based 2D3D IF does not cost in terms of DAP compared to NIF, while it is more favorable compared to 3D3D IF. Additionally, simple Z3 TEVAR cases might be improved by implementing the stiff wire-based 2D3D technique as a result of decreased DAP compared to 3D3D IF and decreased contrast dose compared to NIF.