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Use of 3D imaging in vascular surgery

Philip MacDonald
Supervising Editor
Hospital Healthcare Europe

Modern medicine affords vascular surgery a range of imaging technologies: computed tomography (CT) scans, magnetic resonance angiography (MRA), ultrasound (Duplex) and angiography. But although imaging generally is becoming more and more important in surgical procedures, vascular surgery has its own unique requirements.

According to Professor Hence Verhagen, professor and chief of vascular surgery at Erasmus University Medical Centre in Rotterdam, the Netherlands, the increasing popularity of endovascular procedures played a key role in the growth of imaging’s importance. “With an endovascular procedure,” he says, “you really need imaging to be your eyes during the procedure.

“Usually, with an open abdomen or incision – conventional surgery – you can actually see what you’re doing, and you can see what you have to fix. With endovascular procedures, you’re not able to look through the patient because there’s only a small incision, and usually remote from the place you actually want to do the treatment. So you need imaging to know what you’re doing, both preoperatively and perioperatively, as well as postoperatively, for follow-up.

Although most surgical procedures depend on imaging, and it is becoming increasingly more important across the specialisms, Professor Verhagen highlights the key requirements in procedures relating to the vascular system: “You need imaging to do a lot of measurements beforehand, such as measuring diameter and length of blood vessels, which are essential, so that you know the kind of procedure you’re going to do, and what stents you have to order.”

Endovascular aneurysm repair, the minimally invasive treatment of aneurysmal disease, which involves bringing a stent into the diseased part of the artery through a small incision in the groin, is one procedure that relies heavily on effective 2D and 3D imaging, he adds.

Limitations of scans
Existing CT scans, say Professor Verhagen, have their limitations: “The problem is that, usually, you don’t get reconstructions, just the plain, actual slides. It’s hard to see the three-dimensional properties of the organ you’re interested in if you only have 2D CT scans.

Although it is becoming more and more frequent that basic CT scans come with reconstructions, the difficulty, he continues, lies in that: “You can’t make them yourself; you can’t really enlarge your area of interest. The particular part of the body you’re interested in is usually not the same part as the operator is interested in.

“You can’t make reconstructions yourself, you have to work with the ones they provide you with, but that’s not always very useful.”

3surgeryâ„¢ Vascular Imaging workstation
In seeking to provide a solution to the problem of effective 3D imaging in vascular surgery, one company, 3mensio, consulted Professor Verhagen, in producing their product, 3surgery� Vascular Imaging workstation. “Basically,’ he says, “they knew a lot about computers and reconstructions, but they didn’t know what the customers were looking for.”

Professor Verhagen was, he says, one of 3mensio’s specialist “consultants”, telling the software developers what to look for and what things would be helpful.

Although he is not sure if this element of consultation with specialists in the field is unique, Professor Verhagen says, “You’d imagine it would be a logical thing to do. It is definitely the way to go.”

In summarising the benefits of the product, he describes the 3surgery Vascular Imaging workstation as very quick, easy to handle, intuitive and relatively cheap, adding the fact that it runs on a laptop as a plus.

Vascular Imaging workstation’s good operability is another strongpoint: “It is extremely easy to use,” comments Professor Verhagen. “It is very intuitive, and it does not take much skill to know how it works. This is something that we as consultants told them [the developers] to do, because most imaging software is so difficult to work with, you need to work with it on a daily basis to know how it works. This system is really simple; everybody can learn it, and you don’t have to use it every day to know how it works.”

Professor Verhagen found that when he encountered technical problems he was happy with the product support offered: “You could always call them and there’s someone on the phone, so that’s fantastic. You can send them an email and you get it back the same day. As far as I’ve noticed it’s excellent.”

Given the ease of use and price of 3surgery Vascular Imaging workstation, Professor Verhagen believes there are plenty of uses for the software in other surgical specialisms: “So far, the market is for people involved in vascular diseases. I’m sure that orthopaedic or trauma surgery will benefit from it, as well as brain or abdominal surgery.”