TAVR Abdomen and Pelvis Access

 

Purpose	Quantification of access within the abdomen and pelvis for TAVR
Tag(s)
Panel	Cardiac
Define-AI ID	19040034
Originator	Kimberly Brockenbrough, MD
Lead	Kimberly Brockenbrough, MD
Panel Chair	Carlo De Cecco, MD
Panel Reviewers	Cardiac Panel
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES124

Value Proposition

Transcatheter aortic valve replacement (TAVR) is now the standard of care for treatment of severe aortic stenosis in high risk surgical patients. These indications will likely expand to moderate risk surgical candidates when the long term durability has been shown. According to Grover FL, Vemulapalli S, Carroll JD, et al. in the 2016 annual report of the Society of Thoracic Surgeons/ American College of Cardiology Transcathether Valve Therapy Registry reports nearly 35,000 TAVR procedures performed in 2018. This value has grown between 5,000-10,000 procedures every year since 2012.

Narrative(s)

An 80 year old patient presents to her doctor with new onset of fatigue. She was able to walk for one mile everyday 6 months ago. Now she is short of breath after walking one block. Her doctor ordered an echocardiogram that showed severe aortic stenosis. The patient was seen by a cardiothoracic surgeon and she determined that the patient was not a surgical candidate. The patient is now being evaluated for a TAVR. A CT angiogram of the chest, abdomen and pelvis was performed. An AI algorithm calculates the minimum diameter of the vessels to determine if the vessels are large enough for the catheter to traverse.

Workflow Description

The image is obtained from the CT scanner, sent to the AI algorithm and to the PACS. The CT images are post-processed by the algorithm. The algorithm measures the minimum diameter of the vessels in the abdomen and pelvis. The post-processed images are sent to the PACS.

Procedures(s)	{CTA Abdomen and pelvis}
View(s)	{<1 mm axial source images}
Sex at Birth	{Male, Female}
Age	[0,105]

Inputs

 

DICOM Study

Procedure	CT angiogram of the abdomen and pelvis
Views	< 1 mm slices
Data Type	DICOM
Modality	CT
Body Region	Abdomen and Pelvis
Anatomic Focus	Arteries

Primary Outputs

  

Arterial Minimal Diameters

RadElement ID	RDE804
Definition	Access measurements
Data Type	Numeric
Value Set	Measurements, as above
Units	Millimeters

Minimum diameter of the aorta below the renal arteries

RadElement ID	RDE805
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

Minimum diameter of the right common iliac artery

RadElement ID	RDE806
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

Minimum Diameter of the left Common Iliac Artery

RadElement ID	RDE807
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

  

Minimum Diameter of the right external Iliac Artery

RadElement ID	RDE808
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

Minimum Diameter of the left external Iliac Artery

RadElement ID	RDE809
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

Minimum Diameter of the right common femoral artery

RadElement ID	RDE810
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

Minimum diameter of the left Common Femoral Artery

RadElement ID	RDE811
Definition	minimum diameter in mm, 90 degrees from the minimum diameter in mm
Data Type	Numeric
Value Set	N/A
Units	mm

The algorithm could determine the location of the bifurcation of the femoral arteries in relationship to the femoral heads. Ideally the femoral artery bifurcation is overlying the femoral head. This enables the common femoral artery to be compressed on the femoral head after the catheter is removed. The common femoral artery can also be located above or below the femoral head. This location is important to prevent post-procedural bleeding.