Significant Radiation Reduction Using Cloud-Based AI Imaging in Manually Matched Cohort of Complex Aneurysm Repair

Sabina M. Sorondo,Arash Fereydooni,Vy T. Ho,Shernaz S. Dossabhoy,Jason T. Lee,Jordan R. Stern

Annals of vascular surgery（2025）SCI 4区

Division of Vascular and Endovascular Surgery

Cited 0|Views12

Abstract

Objective Cloud-based, surgical augmented intelligence (Cydar Medical, Cambridge, UK) can be used for surgical planning and intraoperative imaging guidance during complex endovascular aortic procedures. We aim to evaluate radiation exposure, operative safety metrics, and post-operative renal outcomes following implementation of Cydar imaging guidance using a manually matched cohort of aortic procedures. Methods We retrospectively reviewed our prospectively maintained database of endovascular aortic cases. Patients repaired using Cydar imaging were matched to patients who underwent a similar procedure without using Cydar. Matching was performed manually on a 1:1 basis using anatomy, device configuration, number of branches/fenestrations, and adjunctive procedures including in-situ laser fenestration. Radiation, contrast use, and other operative metrics were compared. Pre- and post-operative maximum creatinine was compared to assess for acute kidney injury (AKI) based on RIFLE Criteria. Results 100 patients from 2012-2023 were identified: 50 cases (38 FEVAR, 2 TEVAR, 3 octopus-type TAAA repair, 7 EVAR) where Cydar imaging was used, with suitable matches to 50 non-Cydar cases. Baseline characteristics including BMI did not differ significantly between the two groups (27.8 ± 5.6 vs. 26.7 ± 6.1; P=0.31). Radiation dose was significantly lower in the Cydar group (2529 ± 2256 vs 3676 ± 2976 mGy; P<0.03 Figure 1), despite there being no difference in fluoroscopy time (51 ± 29.4 vs 58 ± 37.2 min; P = 0.37). Contrast volume (94 ± 37.4 vs 93 ± 43.9 mL; P = 0.73), estimated blood loss (169 ± 223 vs 193 ± 222 mL; P = 0.97), and procedure time (154 ± 78 vs 165 ± 89.1 min) did not differ significantly. Additionally, Cydar vs non-Cydar patients did not show a significant difference between pre- and post-creatinine changes (0.13 +/- 0.08 vs 0.05 +/- 0.07; P=0.34). Only one patient in the non-Cydar group met RIFLE criteria for AKI post-operatively. Conclusions The use of cloud-based augmented intelligence imaging was associated with a significant reduction in radiation dose in a cohort of matched aortic procedures but did not appear to affect other parameters or renal function. Even with advanced imaging, surgeons should remain conscientious about radiation safety and administration of nephrotoxic contrast agents.

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Key words

“3D Fusion Imaging”,“Complex Endovascular Aortic Repair”,“Cydar”,“Renal Outcomes” “Radiation Reduction”

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【要点】：本研究评估了基于云的增强智能成像在复杂主动脉手术中使用的辐射暴露、手术安全指标和术后肾功能，结果显示该技术显著降低了辐射剂量，但未影响其他手术参数和肾功能。

【方法】：通过回顾性分析前瞻性维护的数据库，将使用Cydar成像的病例与未使用Cydar的相似病例进行1:1的手动匹配，比较两组的辐射剂量、对比剂使用和其他手术指标。

【实验】：共纳入100名患者（2012-2023年），其中50例使用Cydar成像（包括38例FEVAR，2例TEVAR，3例八爪型TAAA修复，7例EVAR），并与50例未使用Cydar的匹配病例进行比较。结果显示，Cydar组辐射剂量显著低于非Cydar组（2529 ± 2256 vs 3676 ± 2976 mGy；P<0.03），但两组在透视时间、对比剂体积、估计失血量和手术时间上无显著差异。两组术前术后肌酐变化也无显著差异。仅有1例非Cydar组患者在术后符合RIFLE标准的急性肾损伤（AKI）。