Assessment of abdominal branch vessel patency after bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic dissection

Faure, Élodie; Canaud, Ludovic; Cathala, P.; Serres, Isabelle; Marty-Ané, Charles; Alric, Pierre

doi:10.1016/j.jvs.2013.11.095

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…After TEVAR, visceral and renal arteries perfused by the FL showed a significant pressure drop in 55% (12 of 22). 140 Autopsy and animal studies help to understand stentgraft performance and biomechanical aortic changes considerably. Rubin et al 109 reported a fatal case of retrograde AD after TEVAR plus balloon dilation for TBAD.…”

Section: Experimental Analyses Of Aortic Wall and Stent-graft Failuresmentioning

confidence: 99%

“…137,138 In the development stage of TEVAR, Marty-Ané et al 139 reported from an in vivo canine study that complete dissection obliteration could be accomplished only when the entire length of the dissected aorta was treated, as otherwise a false channel continued to exist. 139 Faure et al 140 studied the efficiency of bare metal stenting in 15 human aortic ex vivo models and the impact on visceral and renal arterial patency. Reexpansion of the TL with FL collapse was achieved in all cases.…”

Section: Experimental Analyses Of Aortic Wall and Stent-graft Failuresmentioning

confidence: 99%

“…After TEVAR, visceral and renal arteries perfused by the FL showed a significant pressure drop in 55% (12 of 22). 140…”

Section: Experimental Analyses Of Aortic Wall and Stent-graft Failuresmentioning

confidence: 99%

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Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

et al. 2015

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Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.

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Section: Experimental Analyses Of Aortic Wall and Stent-graft Failuresmentioning

confidence: 99%

Section: Experimental Analyses Of Aortic Wall and Stent-graft Failuresmentioning

confidence: 99%

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Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

et al. 2015

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“…Following, every pose-dependent virtual angioscopy image was created at runtime in MeVisLab using the Open Inventor library [7] from an aorta segmentation of a previous CT scan. The vessel appearance is based on ex vivo and in vivo angioscopies [8,9]. When requested by HoloLens, the last encoded virtual angioscopy image was sent from MeVis-Lab to the AR glasses via Wi-Fi using a remote procedure call (gRPC) [10].…”

Section: Methodsmentioning

confidence: 99%

Catheter pose-dependent virtual angioscopy images visualized on augmented reality glasses

Haxthausen

Jäckle

Strehlow

et al. 2019

Current Directions in Biomedical Engineering

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Fluoroscopy and digital subtraction angiography provide guidance in endovascular aortic repair (EVAR) but introduce radiation exposure and require the administration of contrast agent. To overcome these disadvantages, previous studies proposed to display the pose of an electromagnetically (EM) tracked catheter tip within a three-dimensional virtual aorta on augmented reality (AR) glasses. For further guidance, we propose to create virtual angioscopy images based on the catheter tip pose within the aorta and to display them on HoloLens. The aorta was segmented from the computed tomography (CT) data using MeVisLab software. A landmarkbased registration allowed the calculation of the pose of the EM sensor in the CT coordinate system. The sensor pose was sent to MeVisLab running on a computer and a virtual angioscopy image was created at runtime based on the segmented aorta. When requested by HoloLens, the last encoded image was sent from MeVisLab to the AR glasses via Wi-Fi using a remote procedure call (gRPC), and then decoded and displayed on HoloLens. For evaluation purposes, the latency of transmitting and displaying the images was measured using two different lossy compression formats (namely JPEG and DXT1). A mean latency of 82 ms was measured for the JPEG format. On the other hand, using the DXT1 format, the mean latency was reduced by 87 %. This study proved the feasibility of creating pose-dependent virtual angioscopy images and displaying them on HoloLens. Additionally, the results showed that the DXT1 format outperformed the JPEG format regarding latency. The virtual angioscopy may add valuable additional information for guidance in radiation-sparing EVAR procedure approaches.

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“…The point of view of the catheter, which was incorporated in the initial version of the Nav EVAR prototype [28], was replaced with a virtual angioscopy implemented with Open Inventor library [29]. The appearance of the vessel wall follows that shown in ex vivo and in vivo angioscopies [30], [31].…”

Section: Methodsmentioning

confidence: 99%

Navigation and visualisation with HoloLens in endovascular aortic repair

García-Vázquez

Haxthausen

Jäckle

et al. 2018

Innovative Surgical Sciences

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IntroductionEndovascular aortic repair (EVAR) is a minimal-invasive technique that prevents life-threatening rupture in patients with aortic pathologies by implantation of an endoluminal stent graft. During the endovascular procedure, device navigation is currently performed by fluoroscopy in combination with digital subtraction angiography. This study presents the current iterative process of biomedical engineering within the disruptive interdisciplinary project Nav EVAR, which includes advanced navigation, image techniques and augmented reality with the aim of reducing side effects (namely radiation exposure and contrast agent administration) and optimising visualisation during EVAR procedures. This article describes the current prototype developed in this project and the experiments conducted to evaluate it.MethodsThe current approach of the Nav EVAR project is guiding EVAR interventions in real-time with an electromagnetic tracking system after attaching a sensor on the catheter tip and displaying this information on Microsoft HoloLens glasses. This augmented reality technology enables the visualisation of virtual objects superimposed on the real environment. These virtual objects include three-dimensional (3D) objects (namely 3D models of the skin and vascular structures) and two-dimensional (2D) objects [namely orthogonal views of computed tomography (CT) angiograms, 2D images of 3D vascular models, and 2D images of a new virtual angioscopy whose appearance of the vessel wall follows that shown in ex vivo and in vivo angioscopies]. Specific external markers were designed to be used as landmarks in the registration process to map the tracking data and radiological data into a common space. In addition, the use of real-time 3D ultrasound (US) is also under evaluation in the Nav EVAR project for guiding endovascular tools and updating navigation with intraoperative imaging. US volumes are streamed from the US system to HoloLens and visualised at a certain distance from the probe by tracking augmented reality markers. A human model torso that includes a 3D printed patient-specific aortic model was built to provide a realistic test environment for evaluation of technical components in the Nav EVAR project. The solutions presented in this study were tested by using an US training model and the aortic-aneurysm phantom.ResultsDuring the navigation of the catheter tip in the US training model, the 3D models of the phantom surface and vessels were visualised on HoloLens. In addition, a virtual angioscopy was also built from a CT scan of the aortic-aneurysm phantom. The external markers designed for this study were visible in the CT scan and the electromagnetically tracked pointer fitted in each marker hole. US volumes of the US training model were sent from the US system to HoloLens in order to display them, showing a latency of 259±86 ms (mean±standard deviation).ConclusionThe Nav EVAR project tackles the problem of radiation exposure and contrast agent administration during EVAR interventions by using a multidisciplinary approach to guide the endovascular tools. Its current state presents several limitations such as the rigid alignment between preoperative data and the simulated patient. Nevertheless, the techniques shown in this study in combination with fibre Bragg gratings and optical coherence tomography are a promising approach to overcome the problems of EVAR interventions.

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Assessment of abdominal branch vessel patency after bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic dissection

Abstract: Bare-metal stenting in this model of acute type B aortic dissection was effective in true lumen reexpansion but induced a high (54.5%) rate of significant pressure drop in the visceral and renal arteries when they were supplied by the false lumen.

Cited by 12 publications

References 26 publications

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

Catheter pose-dependent virtual angioscopy images visualized on augmented reality glasses

Navigation and visualisation with HoloLens in endovascular aortic repair

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