Image optimization during endovascular aneurysm repair

OBJECTIVE. The purposes of this review are to examine various properties of the fluoroscopic imaging equipment used during endovascular aneurysm repair (EVAR) that can be modified to reduce radiation dose while optimizing image acquisition and display, to detail geometric aspects of EVAR intraprocedural imaging used to achieve consistently optimal EVAR results, and to describe acquisition parameters and strategies for minimizing contrast-induced nephropathy. CONCLUSION. The outcome of EVAR is strongly linked to image acquisition and interpretation, including the preprocedural, intraprocedural, and postprocedural display of relevant vascular anatomy, positions and configurations of the endograft components, and documentation of successful aneurysm exclusion. Operator familiarity with the imaging equipment, radiation and contrast dose reduction strategies, and image optimization techniques strongly influence the outcome of EVAR.