Intraoperative imaging, navigation and radiation management in aortic and peripheral endovascular procedures

Abstract

Endovascular techniques are essential in treating vascular conditions, to ensure safe and rapid recovery, particularly for elderly and vulnerable patients. Approximately 60% of vascular treatments currently employ endovascular techniques. Within the expanding field of endovascular techniques, there is a growing demand for advanced imaging technology. The current reliance on fluoroscopy has limitations, including exposure to radiation and limited 3D interpretation. This dissertation primarily focuses on reducing radiation exposure and optimizing intraoperative imaging and navigation, with an emphasis on introducing Fiber Optic RealShape (FORS) technology developed by Philips Medical. FORS enables real-time 3D visualization of guidewires and catheters while minimizing radiation use. This innovation promises significant progress in the quality of endovascular treatments. The dissertation also explores other methods to decrease radiation exposure, such as using radiation-absorbing cloths, and provides guidelines for optimizing the operating room setup. Additionally, it offers a comprehensive overview of current imaging and navigation in peripheral endovascular procedures, delving into image fusion—a technique combining conventional real-time fluoroscopy with 3D imaging data. The study focuses on artery displacement during operations and the challenges it poses to guidance accuracy. The dissertation underscores the critical importance of advanced imaging technologies for advancing endovascular techniques and provides practical solutions to overcome current limitations, significantly enhancing the quality of endovascular treatments.