Branched Endovascular Thoracoabdominal Aneurysm Repair Under Electromagnetic Guidance in an in Vitro Model

Abstract

Purpose: We report a new approach to perform endovascular treatment of thoracoabdominal aneurysms under electromagnetic navigation guidance using a modified system (IOPS; Centerline Biomedical, Inc., Cleveland, OH, USA) and a modified branched endograft (E-nside TAAA Multibranch Stent Graft System; Artivion Inc., Kennesaw, GA, USA). Case Report: We performed this case in an aortic in vitro model made from transparent polyurethane in our research hybrid room (Discovery IGS 730; GE HealthCare, Chicago, IL, USA). While the implantation of this device typically involves several challenging steps, including precise endograft implantation, snaring of preloaded guide wires, and cannulation of target visceral arteries, all were successfully performed using electromagnetic navigation guidance. Conclusion: Our preliminary experience suggests that endograft implantation under electromagnetic navigation guidance in an integrated hybrid operating room is an innovative option to address technical challenges and reduce patient and operator radiation exposure associated with complex endovascular surgery. Clinical Impact Most steps of a branched endografting procedure can be performed without X-Ray exposure when using electromagnetic navigation guidance and a modified branched endograft.

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

“…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.…”