CT Three-Dimensional (3D) Modeling Maintains Fluoroscopy Time and Contrast Volume to a Minimum in the Endovascular Treatment of Great Vessel Injury from Iatrogenic Trauma.

ABSTRACT

CT angiography with multislice detector has become the preferred method for assessment of hemodynamically stable patients suspected of great vessel injury from iatrogenic and blunt trauma. The CT images obtained can be transformed into a three-dimensional (3D) model using the software within minutes. This allows the clinician to evaluate the injury and the injury's proximity to other vital structures for operative planning. The 3D modeling provides geometric calibration of the c-arm or image intensifier in regard to optimal cranial/caudal and oblique angles to evaluate and treat the vessel injury. We describe a case of a 28-year-old female undergoing a cesarian section and hysterectomy for placenta percreta, who sustained a right subclavian artery injury (presumed wire injury) from inadvertent right common carotid artery cannulation during placement of a right internal jugular 8 French resuscitative central line. A 3D model was created from the CT angiography to locate the small pseudoaneurysm of the right subclavian artery. The optimal projection was obtained using the 3D reconstructive software to visualize the injury and its relation to the right vertebral artery ostium for endovascular planning. This preoperative maneuver allowed for limited radiation exposure and contrast volume used to treat the injury.