Fiber Optic RealShape (FORS) and three-dimensional overlay technology in preemptive segmental artery embolization to reduce the risk of spinal cord ischemia prior to fenestrated endovascular aortic aneurysm repair

Branched/fenestrated endovascular aortic aneurysm repair (B/FEVAR) carries a risk of spinal cord ischemia (SCI), which increases along with increasing length of aortic luminal coverage of the repair. Pre-emptive coverage with first-stage thoracic endovascular aortic aneurysm repair or embolization of intercostal/lumbar vessels as a staging procedure to reduce the risk of SCI after repair has become commonplace. Intercostal/lumbar embolization can be a technically challenging procedure due to the number of vessels and multiple projections required for cannulation, leading to long procedure times and high radiation/contrast dosing, sometimes requiring multiple sessions to complete. Non-radiation-based imaging modalities such as Lumiguide Fiber Optic RealShape (FORS) by Philips has demonstrated reduction of contrast/fluoroscopy for performance of B/FEVAR and can be particularly useful for procedures requiring multiple imaging views and the resulting high fluoroscopy times/radiation dose. In this case report, we describe the successful utilization of three-dimensional overlay and FORS imaging software in preemptive segmental artery embolization before F/BEVAR to reduce the risk of SCI.