Electromagnetically navigated in situ aortic fenestration for juxtarenal aortic stent grafts was feasible in a healthy animal model. Identified remaining challenges were: shortening the procedure to avoid long warm ischemia times, using an aortic aneurysm animal model, and improving the stability of the stent graft material.

Visualization of electromagnetically tracked instruments in pre- or intra-interventional fluoroscopic images requires a registration process between the coordinate systems of both modalities. We present in this paper a new approach for performing this procedure by using only two external fiducial markers with integrated electromagnetic sensors which are applied on the patient's skin. Combined with the information acquired by the fluoroscopic system we achieve an automated and fast registration.

This work presents concepts for complex endovascular procedures using electromagnetic navigation technology (EMT). Navigation software interfacing a standard commercially available navigation system was developed, featuring registration, electromagnetic field distortion correction, breathing motion detection and gating, and state-of-the-art 3D imaging post processing. Protocols for endovascularly placed, in-situ fenestrated abdominal aortic stent grafts and an EMT guided transjugular intrahepatic portosystemic shunt (TIPSS) creation have been designed. A dedicated set of interventional devices was developed for each of the procedures: For aortic in-situ fenestration a combination of high-porosity stentgrafts, steerable catheters and electromagnetically navigated guidewires was used, for TIPSS a dual-navigated (sheath and stylet) TIPSS-device was designed and manufactured. The developed devices underwent phantom testing, in preparation for animal experiments to prove the feasibility of the approach. Once established, these systems could aid in performing these challenging interventional radiology procedures, exploiting the unique characteristics of electromagnetic navigation and solving multiple of the problems associated with these interventions being performed under X-ray fluoroscopy, such as lacking real-time 3D information or extensive exposure to ionizing radiation.

Superimposition of the occluded coronary artery and the regional myocardial viability was achieved using automated multimodality fusion of coronary angiograms and stress echocardiograms with in vitro experiments. This system is promising for integrated single step angiography and angioplasty that may reduce procedure time, cost and length of hospitalization. Further testing in vivo is needed to verify and validate the system in a clinical setting.

TIPS creation with the use of electromagnetic tracking technology proved to be feasible in-vitro as well as in-vivo. The system may be useful to facilitate challenging TIPSS procedures.