Images in Cardiovascular Medicine Zero-Contrast Thoracic Endovascular Aortic Repair Using Image Fusion

In recent years, thoracic endovascular aortic repair (TEVAR) hasbeen established as a reliable alternative to conventional surgical repair.1 The success of endovascular repair is criti-cally dependent on adequate stent-graft deployment. Catheter-based 2-dimensional angiography is routinely per-formed before, during, and after stent-graft placement to ensure accurate positioning and confirm the absence of complications such as perigraft endoleaks. Computed tomog-raphy angiography (CTA) is also used to plan stent-graft deployment before intervention. Recent advances in imaging technology allow reusing the diagnostic volumetric data sets during intervention by overlying live fluoroscopy over the preacquired CTA.2 This article describes the first case of TEVAR under guidance of CTA superimposed on live fluoroscopy without the use of iodinated contrast agent before, during, and after deployment