In Journal of vascular surgery ; h5-index 87.0
OBJECTIVES : The introduction of endovascular procedures has revolutionized the management of complex aortic aneurysms. Although repairs traditionally require longer operative times and increased radiation exposure compared to simple endovascular aneurysm repairs, the recent introduction of 3D technology has become an invaluable operative adjunct. Surgical augmented intelligence (AI) is a rapidly evolving tool initiated at our institution in June 2019. Our study aims to show that this technology improves patient and operator safety.
METHODS : A retrospective review of patients who underwent endovascular repair of complex aortic aneurysms (pararenal, juxtarenal, or thoracoabdominal), type B dissection, or infrarenal (endoleak, coil placement, or renal angiogram with or without intervention) at a tertiary care center from August 2015 to November 2021 was performed. Patients were stratified based on the use of intelligent maps, which are patient-specific AI tools used in the operating room in conjunction with real-time fluoroscopic images. Primary outcomes included operative time, radiation exposure, fluoroscopy time, and contrast use. Secondary outcomes included 30-day postoperative complications and long-term follow-up. Linear regression models were used to evaluate the association between AI use and main outcomes.
RESULTS : Over the six-years, 116 patients were included with no significant difference in baseline characteristics; 76 (65.5%) patients underwent procedures using AI while 40 (34.5%) did not use AI software. Intraoperative outcomes revealed a significant decrease in radiation exposure - 1955 mGy in the AI group compared to 3755 mGy in the non-AI group (p=.004), a significant decrease in fluoroscopy time - 55.6 minutes in the AI group versus 86.9 minutes in the non-AI group (p=.007), a decrease in operative time - 255 minutes in the AI group versus 284 minutes in the non-AI group (p=0.294), and a significant decrease in contrast used - 123cc in the AI group versus 199cc in the non-AI group (p<0.0001). There was no difference in 30-day and long-term outcomes.
CONCLUSION : This study demonstrates the use of AI technology combined with intraoperative imaging significantly facilitates complex endovascular aneurysm repair by decreasing operative time, radiation exposure, fluoroscopic time, and contrast usage. Overall, evolving technology such as AI has improved radiation safety for both the patient and entire operating room team.
Patel Rohini J, Lee Arielle M, Hallsten John, Lane John S, Barleben Andrew R, Malas Mahmoud B
2022-Dec-26
Aortic Aneurysm, Artificial Intelligence, Radiation
