Imaging Fusion Guidance for Endovascular Aorto-Iliac Procedures: A Systematic Review and Meta-Analysis

Objectives: We aimed to report the latest and most comprehensive pooled analysis and evidence update, comparing the perioperative outcomes and radiation exposure of endovascular aorto-iliac procedures utilizing imaging fusion (IF) guidance versus conventional imaging techniques. Patients and Methods: We performed a systematic literature search using PubMed, Cochrane Library, Embase, and Web of Science up to Oct 2023 for studies that evaluate the effect of IF technology in endovascular treatment on the perioperative outcomes and radiation exposure and published in English. Outcomes measured were procedure time, fluoroscopy time, contrast medium, dose-area product (DAP), radiation doses, length of stay, technical success, the postoperative 30-day mortality, and any major adverse event. Results: A total of 13 eligible articles involving 1498 patients (732 IF vs 766 Control) were included for the evidence synthesis. Baseline characteristics of the 2 groups were similar in all outcomes except that lower previous aortic disease was observed in the control group. Pooled analysis showed shorter procedure time, fluoroscopy time, contrast medium, DAP, and radiation doses in the IF group. No significant differences were observed in the remaining indicators. Conclusions: Given the presence of heterogeneity and potential bias, vascular surgeons should select the imaging strategy based on their experience and patient-specific factors. Clinical Impact This study provides compelling evidence supporting the integration of imaging fusion (IF) technology into endovascular aorto-iliac procedures. IF significantly reduces procedure time, contrast medium usage, and radiation exposure—key factors for patient safety, particularly in those with renal impairment. By improving anatomical visualization without increasing adverse outcomes, IF offers clinicians a safer, more efficient alternative to conventional imaging. Its impact is most pronounced in the treatment of dilated aortic lesions, where complex vascular anatomy demands precise navigation. These findings may shift clinical practice toward broader adoption of IF guidance in high-risk or anatomically challenging cases, aligning procedural innovation with improved patient care.