Software Application Makes AAA Stent Placement Easier

A novel application package enables automated fusion imaging support for minimally invasive endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).

The Siemens Healthcare (Erlangen, Germany) Evar Guidance Engine software application supports the entire surgical process using automated workflows, from analysis of the pre-procedural computerized tomography (CT) images, to image-supported intervention, and even including intra-operative three-dimensional (3D) monitoring. The process begins when the CT image is prepared automatically for overlaying with the two-dimensional (2D) x-ray image, a process known as fusion imaging.


The Evar Guidance Engine also recognizes the vessel walls in the aorta, and marks the main vessels branching away from it. At this point the anatomical markings identified on the pre-procedural CT image can be displayed on the x-ray image to serve as a guide for the surgeon, calculate the ideal angulation for the C-arm, and enable the stent to be precisely positioned. The use of fusion imaging reduces both the radiation dose required and the dose of contrast media for the patient, compared to traditional methods without 3D imaging support.

Intra-operative 3D imaging also enables results to be assessed immediately following surgery using proprietary syngo DynaCT 3D imaging, a contrast-enhanced cone beam CT technique that enables endograft-associated or other complications to be detected immediately and repaired while the patient is still on the operating table. The Evar Guidance Engine will be available as part of the pure platform for the Siemens Healthcare Artis zee, Artis Q, Artis zeego, and Artis Q.zen angiography systems.

“The optical system is an absolute winner, since you always have all the key orientation points in view. I can always see where the renal artery is, and which angulation I need to select,” said Philipp Geisbuesch, MD, a vascular surgeon at University Hospital Heidelberg (Germany). “Fusion imaging enables us to place the endograft with maximum accuracy and the correct angulation, all with minimum use of contrast media.”

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University Hospital Heidelberg