Three-Dimensional Electromagnetic Navigation vs. Fluoroscopy for Endovascular Aneurysm Repair: A Prospective Feasibility Study in Patients

Manstad-Hulaas, Frode; Tangen, Geir; Dahl, Torbjørn; Hernes, Toril A. Nagelhus; Aadahl, Petter

doi:10.1583/11-3557.1

Cited by 35 publications

(27 citation statements)

References 12 publications

(12 reference statements)

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“…This trend of a reduction in x-ray exposure with IF guidance needs to be further investigated to confirm our preliminary results. Although multiple methods of image guidance (eg, 3D electromagnetic navigation) are available, clinical experience in aortic grafting remains limited (29–31). …”

Section: Discussionmentioning

confidence: 99%

Image Guidance for Endovascular Repair of Complex Aortic Aneurysms: Comparison of Two-dimensional and Three-dimensional Angiography and Image Fusion

Tacher¹,

Lin²,

Desgranges³

et al. 2013

Journal of Vascular and Interventional Radiology

132

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Purpose To evaluate the feasibility of image fusion (IF) of preprocedural arterial-phase computed tomography with intraprocedural fluoroscopy for roadmapping in endovascular repair of complex aortic aneurysms, and to compare this approach versus current roadmapping methods (ie, two-dimensional [2D] and three-dimensional [3D] angiography). Materials and Methods Thirty-seven consecutive patients with complex aortic aneurysms treated with endovascular techniques were retrospectively reviewed; these included aneurysms of digestive and/or renal arteries and pararenal and juxtarenal aortic aneurysms. All interventions were performed with the same angiographic system. According to the availability of different roadmapping software, patients were successively placed into three intraprocedural image guidance groups: (i) 2D angiography (n = 9), (ii) 3D rotational angiography (n = 14), and (iii) IF (n = 14). X-ray exposure (dose–area product [DAP]), injected contrast medium volume, and procedure time were recorded. Results Patient characteristics were similar among groups, with no statistically significant differences (P ≥ .05). There was no statistical difference in endograft deployment success between groups (2D angiography, eight of nine patients [89%]; 3D angiography and IF, 14 of 14 patients each [100%]). The IF group showed significant reduction (P < .0001) in injected contrast medium volume versus other groups (2D, 235 mL ± 145; 3D, 225 mL ± 119; IF, 65 mL ± 28). Mean DAP values showed no significant difference between groups (2D, 1,188 Gy · cm2 ± 1,067; 3D, 984 Gy · cm2 ± 581; IF, 655 Gy · cm2 ± 457; P = .18); nor did procedure times (2D, 233 min ± 123; 3D, 181 min ± 53; IF, 189 min ± 60; P = .59). Conclusions The use of IF-based roadmapping is a feasible technique for endovascular complex aneurysm repair associated with significant reduction of injected contrast agent volume and similar x-ray exposure and procedure time.

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Section: Discussionmentioning

confidence: 99%

Image Guidance for Endovascular Repair of Complex Aortic Aneurysms: Comparison of Two-dimensional and Three-dimensional Angiography and Image Fusion

Tacher¹,

Lin²,

Desgranges³

et al. 2013

Journal of Vascular and Interventional Radiology

132

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“…To make things even more confusing, RMN is sometimes combined with EM tracking to localize the steerable catheter during the intervention [178]. Other catheter applications using EM tracking are rare in the literature, but there are examples of aortic [103], neurovascular [4], and vena cava catheterizations [171]. Transjugular Intrahepatic Portosystemic Stent Shunting (TIPSS) was also tested in a phantom trial [95].…”

Section: A Range Of Applicationmentioning

confidence: 99%

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Franz

Haidegger

Birkfellner

et al. 2014

IEEE Trans. Med. Imaging

365

273

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Abstract-Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without lineof-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.

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“…Seven articles on two EM ENSs were included: two articles reported the StealthStation TREON Plus (Medtronic Inc, Minneapolis, Minn) 23,24 tracking system, and five articles reported the Aurora (Northern Digital, Waterloo, Ontario, Canada) tracking system. 19,21,22,29,33 An EM ENS consists of (1) a magnetic-field generator that generates an ultra-low EM field and must be located near the surgical field, (2) EM position coils integrated at the tip of the manual endovascular device that induce a characteristic in the coil determined by the specific location and distance of the coil in the EM field, (3) a control box that converts the voltage in the EM coil into digital data for the exact 3D position of the coil, and (4) navigation software for image guidance. These four components provide the 3D position and orientation of the EM coils (and thus the endovascular devices) and visualize the location of the coil in a preoperative computed tomography (CT) scan.…”

Section: Resultsmentioning

confidence: 99%

“…The two-lumen catheter was also tested in a clinical study in which the sensor was positioned at the tip, and by heating the catheter, the tip could be bent into different angles. 33 ULS tracking system. Two studies report a ULS, 10,28 which consists of an (1) endovascular device with a 3.5-MHz piezoelectric ultrasound transmitter integrated in the tip of a catheter to signal its location with ultrasound waves, (2) an external array of sensors attached on the body surface that receives signal locations through the use of ultrasound gel, and (3) navigation software to visualize the 3D device coordinates and enable registration with preoperative 3D CT.…”

Section: Resultsmentioning

confidence: 99%

Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair

Ruiter

Moll

Herwaarden

2015

Journal of Vascular Surgery

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This review summarizes the current studies on manual tracking and robotic navigation systems for application in EVAR. The main focus of these systems is improving aortic vessel cannulation, required in complex EVAR, in which the robotic system with the improved steerability is favored over manual tracking systems or conventional cannulation. All reviewed tracking systems still require X-ray for anatomic imaging, stent graft deployment, and device registration. Although the current reviewed endovascular navigation systems have shown their potential in phantom and animal studies, clinical trials are too limited to conclude that these systems can improve EVAR outcomes or that they can systematically reduce FTs, radiation doses, and contrast volumes during (complex) EVAR.

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Three-Dimensional Electromagnetic Navigation vs. Fluoroscopy for Endovascular Aneurysm Repair: A Prospective Feasibility Study in Patients

Cited by 35 publications

References 12 publications

Image Guidance for Endovascular Repair of Complex Aortic Aneurysms: Comparison of Two-dimensional and Three-dimensional Angiography and Image Fusion

Image Guidance for Endovascular Repair of Complex Aortic Aneurysms: Comparison of Two-dimensional and Three-dimensional Angiography and Image Fusion

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair

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