Novel EM Guided Endovascular Instrumentation for In Situ Endograft Fenestration

Condino, Sara; Ferrari, Vincenzo; Ferrari, Mauro; Piazza, Roberta; Viglialoro, Rosanna Maria; Mocellin, Davide M; Turini, Giuseppe; Berchiolli, Raffaella; Micheletti, Filippo; Rossi, Francesca; Pini, Roberto

doi:10.1109/jtehm.2020.2973973

Cited by 6 publications

(5 citation statements)

References 31 publications

(43 reference statements)

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“…Recently, another group has demonstrated the use of a de novo trackable and steerable catheter for in situ fenestration. 6 The catheter had a bendable catheter tip allowing for 90° bend to allow for perpendicular positioning to the stent graft. The catheter was tested in a rigid model with good technical success.…”

Section: Discussionmentioning

confidence: 99%

“… 4 Recently, the combination of EM tracking with steerable catheters or sheaths has been proposed for complex cannulation tasks. 5 , 6 In a further attempt to combine the agility of a steerable catheter with the 3D visualization provided with EM tracking, a steerable catheter with an embedded EM sensor was developed. 7 The aim of this swine model study was 2-fold.…”

Section: Introductionmentioning

confidence: 99%

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A Steerable and Electromagnetically Tracked Catheter: Navigation Performance Compared With Image Fusion in a Swine Model

et al. 2022

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Purpose: Cannulation of visceral vessels is necessary during fenestrated and branched endovascular aortic repair. In an attempt to reduce the associated radiation and contrast dose, an electromagnetically (EM) trackable and manually steerable catheter has been developed. The purpose of this preclinical swine study was to evaluate the cannulation performance and compare the cannulation performance using either EM tracking or image fusion as navigation tools. Materials and Methods: Both renal arteries, the superior mesenteric artery, and the celiac trunk were attempted to be cannulated using a 7F steerable, EM trackable catheter in 3 pigs. Seven operators attempted cannulation using first 3-dimensional (3D) image navigation with EM tracking and then conventional image fusion guidance. The rate of successful cannulation was recorded, as well as procedure time and radiation exposure. Due to the lack of an EM trackable guidewire, cannulations that required more than 1 attempt were attempted only with image fusion. The EM tracking position data were registered to preoperative 3D images using a vessel-based registration algorithm. Results: A total of 72 cannulations were attempted with both methods, and 79% (57) were successful on the first attempt for both techniques. There was no difference in cannulation rate (p=1), and time-use was similar. Successful cannulation with image fusion was achieved in 97% of cases when multiple attempts were allowed. Conclusion: This study demonstrated the feasibility of a steerable and EM trackable catheter with 3D image navigation. Navigation performance with EM tracking was similar to image fusion, without statistically significant differences in cannulation rates and procedure times. Further studies are needed to demonstrate this utility in patients with aortic disease. Clinical Impact Electromagnetic tracking in combination with a novel steerable catheter reduces radiation and contrast media doses while providing three-dimensional visualization and agile navigation during endovascular aortic procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Steerable and Electromagnetically Tracked Catheter: Navigation Performance Compared With Image Fusion in a Swine Model

et al. 2022

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“…Intravascular ultrasound probes were not able to visualize the renal orifices for fenestration both within the stent graft and within the inferior vena cava[ 6 ]. However, electromagnetically guided endovascular instrumentation was successful in in vitro trials[ 11 , 12 ]. Therefore, in our case, fenestration was performed while the stent graft was positioned well with the bare stent region unreleased, allowing real-time positioning by angiography.…”

Section: Discussionmentioning

confidence: 99%

“…If endovascular therapy is deemed to be the best treatment option, antegrade ISF may be an ideal method to preserve the patency of visceral arteries. Many animal experiments[ 6 - 9 ], benchtop studies[ 10 - 12 ], and clinical studies[ 13 - 17 ] have demonstrated that the antegrade ISF of aortic stent grafts during EVAR is technically feasible. The following report describes a novel approach of antegrade in situ laser fenestration (ISLF) during EVAR.…”

Section: Introductionmentioning

confidence: 99%

Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair: A case report

Wang¹,

Qiao²,

Li³

et al. 2022

WJCC

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BACKGROUND The endovascular repair of juxtarenal abdominal aortic aneurysms (JAAA) usually requires combination treatment with various stent graft modifications to preserve side branch patency. As a feasible technique, according to the situation, antegrade in situ laser fenestration still needs to be improved. CASE SUMMARY This report describes a case that was successfully treated with endovascular repair facilitated by antegrade in situ laser fenestration while maintaining renal arterial flow. Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of the renal artery ostium. With the bare stent region unreleased, renal artery perfusion could be maintained and accurate positioning could be achieved by angiography in real time. CONCLUSION This study suggests the feasibility and short-term safety of this novel antegrade in situ laser fenestration technique for select JAAA patients.

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“…To reduce radiation and contrast dose, electromagnetic (EM) tracking of instruments with registration to preoperative computed tomography angiography (CTA) can be an appealing supplement. EM tracking has been demonstrated in feasibility studies, including in-situ fenestration of stent graft and cannulation of branch vessels (1)(2)(3)(4)(5)(6)(7). Most reported results are from in vitro phantom experiments, some from in-vivo animal studies, but very limited from patients.…”

Section: Introductionmentioning

confidence: 99%

Endovascular navigation in patients: vessel-based registration of electromagnetic tracking to preoperative images

Nypan,

Tangen,

Brekken

et al. 2024

Front. Radiol.

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Electromagnetic tracking of instruments combined with preoperative images can supplement fluoroscopy for guiding endovascular aortic repair (EVAR). The aim of this study was to evaluate the in-vivo accuracy of a vessel-based registration algorithm for matching electromagnetically tracked positions of an endovascular instrument to preoperative computed tomography angiography. Five patients undergoing elective EVAR were included, and a clinically available semi-automatic 3D–3D registration algorithm, based on similarity measures computed over the entire image, was used for reference. Accuracy was reported as target registration error (TRE) evaluated in manually selected anatomic landmarks on bony structures, placed close to the volume-of-interest. The median TRE was 8.2 mm (range: 7.1 mm to 16.1 mm) for the vessel-based registration algorithm, compared to 2.2 mm (range: 1.8 mm to 3.7 mm) for the reference algorithm. This illustrates that registration based on intraoperative electromagnetic tracking is feasible, but the accuracy must be improved before clinical use.

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Novel EM Guided Endovascular Instrumentation for In Situ Endograft Fenestration

Cited by 6 publications

References 31 publications

A Steerable and Electromagnetically Tracked Catheter: Navigation Performance Compared With Image Fusion in a Swine Model

A Steerable and Electromagnetically Tracked Catheter: Navigation Performance Compared With Image Fusion in a Swine Model

Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair: A case report

Endovascular navigation in patients: vessel-based registration of electromagnetic tracking to preoperative images

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