This 3D navigation system demonstrates good ex vivo accuracy and is sufficiently accurate in vivo to explore its potential for improved endovascular navigation.

A 3D EM navigation system, used in conjunction with fluoroscopy and angiography, has the potential to provide more spatial information and reduce the use of radiation and contrast during endovascular interventions. This pilot study showed that 3D EM navigation is feasible in patients undergoing EVAR. However, a larger study must be performed to determine if 3D EM navigation is better than the existing practice for these patients.

Electromagnetic guided bronchoscopy is a new field of research, essential for the development of advanced investigation of the airways and lung tissue. Consecutive problem-based solutions and refinements are urgent requisites to achieve improvements. For that purpose, our intention is to build a complete research platform for electromagnetic guided bronchoscopy. The experimental interventional electromagnetic field tracking system in conjunction with a C-arm cone beam CT unit is presented in this paper. The animal model and the navigation platform performed well and the aims were achieved; the 3D localization of foreign bodies and their navigated and tracked removal, assessment of tracking accuracy that showed a high level of precision, and assessment of image quality. The platform may prove to be a suitable platform for further research and development and a full-fledged electromagnetic guided bronchoscopy navigation system. The inclusion of the C-arm cone beam CT unit in the experimental setup adds a number of new possibilities for diagnostic procedures and accuracy measurements. Among other future challenges that need to be solved are the interaction between the C-arm and the electromagnetic navigation field, as we demonstrate in this feasibility study.

Objective: To evaluate the feasibility of a side-branched stent graft inserted in an artificial abdominal aortic aneurysm (AAA), using navigation technology, and to compare procedure duration and dose of radiation with control trials. Methods: A custom-made stent graft was inserted into an artificial AAA using navigation technology in combination with fluoroscopy. The navigation technology was based on three-dimensional visualization of computed tomography data and electromagnetic tracking of microposition sensors. The stent graft had integrated position sensors in side branch and introducer and was guided into proper position with the aid of three-dimensional images. Control trials were performed with fluoroscopy alone. Results: It was feasible to insert a side-branched stent graft using three-dimensional navigation technology. The navigation-guided trials had a significantly lower X-ray load (p < 0.001), but showed no difference in the duration of the procedures (p = 0.34) as compared with controls. Conclusions: Inserting a side-branched stent graft in an artificial AAA using navigation technology is feasible. Side-branched stent grafts and navigation systems may become useful in the endovascular treatment of complicated aortic aneurysms.

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Background Percutaneous transluminal angioplasty (PTA) is an established treatment of arteriovenous fistula (AVF) stenosis. Drug-coated balloons (DCB) are coated with an antiproliferative drug intended to decrease neointimal hyperplasia and restenosis. Purpose To investigate the patency after treatment of restenosis in radiocephalic AVFs with PTA versus DCB. Material and Methods A retrospective study comprising 26 patients, recruited from treatment registers, receiving at least one previous PTA and a re-intervention (13 PTAs and 13 DCBs) at the same anatomic location, were observed for 24 months. Patency after re-intervention was compared between the two cohorts. Furthermore, an intra-subject analysis, comparing patency before and after DCB, was performed in the DCB cohort. The Kaplan–Meier method was used to estimate the proportion of stenosis-free patients at different time points after treatment. Results After 12 and 24 months, the estimated proportions of stenosis-free patients were 61% and 31%, respectively, in the DCB cohort, compared to 40% and 15% in the PTA cohort. In the intra-subject analysis, 15% and 8% of the patients treated with PTA remained stenosis-free after 12 and 24 months, respectively. Patients treated with DCB had significantly longer patency than patients in the PTA cohort (median 16 vs. 5 months, respectively; P = 0.05). Additionally, in the intra-subject analysis, patency after DCB treatment exceeded PTA (median 16 vs. 5 months, respectively; P = 0.01). Conclusion Our results indicate that DCB angioplasty is associated with significantly improved patency in the treatment of restenosis in radiocephalic AVFs. A longer follow-up or randomized controlled trial is warranted.