Augmented reality navigation to assist retrograde peroneal access for the endovascular treatment of critical limb ischemia

Abstract

Retrograde access is an alternative approach to endovascular intervention for critical limb ischemia but may be challenging in patients with poor below-knee vessel runoff. Here, we introduce an innovative technique based on an augmented reality navigation system to gain successful retrograde access to the peroneal artery of an 84-year-old woman with critical limb ischemia. Our result showed that this innovative technique had the potential advantage of influencing target vessel access selection with lower contrast material volume and radiation exposure compared with the conventional approach. More in-depth study is required to investigate the safety and efficacy of augmented reality-assisted vascular interventions.

Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review

“…Eight papers out of 11, report the use of HMDs or Smart Glasses (11)(12)(13)(14)(15)(16)(17)(18). These displays provide the user with an egocentric viewpoint and allow operators to work hands-free, and according to recent literature (22,23), they have been deemed the most ergonomic solution for applications including manual tasks performed by the user under direct vision, like what happens in open surgery.…”

“…Among them, some papers (11,12,18,19) do not focus on a specific surgical procedure but describe more extensively the usefulness of AR in endovascular surgery. The rest propose the following use cases: endovascular treatment of abdominal aortic aneurysms (EVAR) (12, 16, 14, 15), peripheral angioplasty (13,17,16), and carotid angioplasty (16). The remaining papers concern:…”

“…Four out of 11 papers concern an application specifically designed for intraoperative navigation, without providing EM localization of the instrumentation (20,13,18,21). More particularly, the system developed by Aly et al (20) is conceived to assist the surgeon in the localization of vascular structures via the AR visualization of a 3D model of the patient vasculature, extracted from preoperative CTA, registered to the patient body and displayed via a smartphone.…”

“…More particularly, the system developed by Aly et al (20) is conceived to assist the surgeon in the localization of vascular structures via the AR visualization of a 3D model of the patient vasculature, extracted from preoperative CTA, registered to the patient body and displayed via a smartphone. Lu et al propose an application to ease retrograde peroneal access for the endovascular treatment of critical limb ischemia (13). The application is based on the use of an AR navigation system (Xiamen Minwei Limited Company, Xiamen, China) featuring AR glasses that are employed by the authors to visualize the recommended puncture path (site, depth, and angle of puncture) to the target vessel.…”

“…Moreover, HMDs such as Microsoft HoloLens can be operated by voice commands and gestures, they do not need to be handled, leaving hands free and maintaining the sterility of the environment (16). In the field of navigation, AR has the potential to lower contrast material volume and radiation exposure without interfering with the operator's routine activities (13,15), to ease procedures and improve their accuracy (15), to decrease surgical time (15). This review also highlights several limitations of current technologies that hinder their widespread use in clinical settings.…”