Early Concepts in CT Image-Guided Robotic Vascular Surgery: The Displacement of Retroperitoneal Structures During Simulated Procedures in a Cadaveric Model.

Background: CT image guidance and navigation, although routinely used in complex endovascular procedures, is an unexplored territory in evolving vascular robotic procedures. In robotic surgery, it promises the better localization of vasculature, the optimization of port placement, less inadvertent tissue damage, and increased patient safety during the dissection of retroperitoneal structures. However, unknown tissue displacement resulting from induced pneumoperitoneum and positional changes compared to the preoperative CT scan can pose significant limitations to the reliability of image guidance.

Feasibility of a sutureless anastomotic technique in robot-assisted vascular surgery.

While other specialties embraced robotic technology, vascular surgery was revolutionized by endovascular techniques. The combination of open surgical techniques with endovascular solutions became standard practice; however, it is considered an unexplored frontier in the evolving field of robotic vascular procedures. One of the criticisms against robotics is the difficulty of vascular anastomosis.

CT-guided biopsy in heterotopic heart transplant: A case report.

Background: Heterotopic heart transplantation is a surgical technique that has not been embraced broadly. In this historic technique, the donor heart is sutured in parallel to the recipient heart with both hearts in place.

Case Summary: We report a patient who received a heterotopic heart transplant at our institution more than 15 years ago with preserved cardiac function and who needed a myocardial biopsy due to heart failure symptoms.

Cinematic Rendered Computed Tomography Imaging Enhances 3D Visualization of Upper Extremity Arteriovenous Malformation.

Inspired by the quality of computer-rendered images in the animated movie industry, cinematic rendering (CR) is a novel image visualization technique using proprietary rendering algorithms that simulate the propagation and interaction of light rays passing through 3-dimensional (3D) volumetric data, resulting in a photorealistic representation of bodily organs and vasculature. Due to its more realistic representative and intuitive format, it has become part of medical education, especially 3D anatomy teaching, patient education, and communication. It also plays an important role in the diagnostics and treatment planning for complex vascular pathologies, especially malformations.

Retrospective Comparison of Stiff Wire-Based 2D3D, Traditional 3D3D Image Fusion, and Non-Image Fusion Techniques and Their Role in Thoracic Aortic Endovascular Repair.

: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. : A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included.

Robot-assisted vascular surgery: literature review, clinical applications, and future perspectives.

Although robot-assisted surgical procedures using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) have been performed in more than 13 million procedures worldwide over the last two decades, the vascular surgical community has yet to fully embrace this approach (Intuitive Surgical Investor Presentation Q3 (2023) https://investor.intuitivesurgical.com/static-files/dd0f7e46-db67-4f10-90d9-d826df00554e .

Experimental multiparametric magnetic resonance imaging characterization of iliocaval venous thrombosis pathological changes.

Objective: Iliocaval thrombotic obstruction is a challenging condition, especially because thrombus age and corresponding pathological remodeling at presentation are unknown, which directly impacts management. Our aim was to assess the ability of magnetic resonance imaging (MRI) in determining age thresholds of experimentally created inferior vena cava (IVC) thrombosis in pigs.

Methods: We used a previously described swine model of IVC thrombosis.

Image Guidance Techniques and Treatment Approach Optimization in the Management of Type-II Endoleak After Endovascular Aortic Aneurysm Repair.

Background: Over the past 3 decades endovascular aortic aneurysm repair emerged as the primary approach for abdominal aortic aneurysm management, however the occurrence of endoleak following endograft implantation imposes a high toll on patients and hospitals alike. The early diagnosis and appropriate treatment of endoleaks is associated with better outcomes, which calls for more advanced imaging and a standardized approach for endoleak diagnosis and management following endovascular aortic aneurysm repair. Although conventional strategy with non-targeted deployment of coils and embolic material in the aneurysm sac is considered to be the standard approach in many hospitals, it may not prove to be a viable option, given that it affects any further follow-up imaging in the event of sub-optimal therapy and consequent recurrence.

Endovascular retrieval of a fractured Optease inferior vena cava filter using endobronchial forceps and intraoperative cone-beam computed tomography guidance.

Endovascular retrieval of fractured inferior vena cava (IVC) filters after the manufacturer recommended indwelling time can be challenging and require advanced retrieval techniques. We describe an endovascular retrieval technique of a fractured Optease IVC filter in a 57-year-old woman using endobronchial forceps and intraoperative cone-beam computed tomography guidance. Following incomplete filter retrieval, the location and orientation of fractured strut was confirmed by cone-beam computed tomography venography.

Cadaveric aortic aneurysm creation: A life-like model for training endovascular repair.

The recent decline in RAAA incidence and the fast paced scenario with associated challenges regarding training calls for initiative for a better training environment to maximize learning. This led us to the creation of a pulsatile human cadaveric RAAA model. Fresh frozen cadaver was used to create RAAA with BioTissue in hybrid suite with ability to perform CBCTA for sizing.

Emerging Applications for Computer Vision and Artificial Intelligence in Management of the Cardiovascular Patient.

Artificial intelligence and telemedicine promise to reshape patient care to an unprecedented extent, leading to a safer and more sustainable work environment and improved patient care. In this article, we summarize how these emerging technologies can be used in the care of cardiovascular patients in such ways as fall detection and prevention, virtual nursing, remote case support, automation of instrument counts in the operating room, and efficiency optimization in the cardiovascular suite.

Dynamic Imaging of Aortic Pathologies: Review of Clinical Applications and Imaging Protocols.

The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies.

Single-Center Experience With Aortic Coarctation Stenting in Adult Patients.

Objective: Endovascular repair of aortic coarctation (CoA) has become an important tool in the treatment of an expanding patient population. In this study, we present our 10-year experience with endovascular repair of CoA.

Methods: Between January 2012 and January 2022, a total of 15 patients were treated at our Institution for CoA with catheter-based techniques.

Endovascular ascending aortic pseudoaneurysm repair under image fusion guidance and transcranial Doppler monitoring.

We describe a 78-year-old woman with a large ascending aortic pseudoaneurysm who underwent thoracic endovascular aortic repair under intraoperative image fusion guidance and real-time transcranial Doppler (TCD) monitoring. TCD monitoring revealed a total of 419 microembolic signals throughout the procedure, with the majority occurring as the first stent graft crossed the ascending aorta. Two days later, she underwent endovascular repair of a graft type IA endoleak.

Added Value of Selective Intra-arterial Cone-Beam CT Angiography in the Management of Visceral Artery Aneurysms.

Purpose: The aim of this study is to evaluate the value of selective intra-arterial cone-beam computed tomography angiography (CBCTA) relative to conventional computed tomography angiography (CTA) in understanding visceral artery aneurysm (VAA) morphology, and its impact on treatment planning.

Materials And Methods: Between January 2017 and August 2021, all patients who had a diagnosis of VAA and underwent intraoperative CBCTA imaging were retrospectively reviewed. Impact on treatment decisions, optimal C-arm angulations derived from CBCTA, and additional radiation exposure were reported.

Advanced intraoperative imaging guidance for inside-out central venous recanalization using a novel catheter access system.

Background: The novel Surfacer Inside-Out recanalization technique facilitates right-sided central venous access in occluded vessels but carries a risk of arterial and pleural injuries. This article demonstrates how an advanced intraoperative imaging protocol can help to avoid these potential complications.

Methods: This retrospective review included patients undergoing the Surfacer Inside-Out central venous recanalization procedure between December 2017 and October 2021.

"Octafen": A Noninvestigational Alternative Endograft Configuration for the Treatment of Thoracoabdominal Aortic Aneurysms.

Purpose: To demonstrate the feasibility of Octafen technique, a novel endovascular configuration for the treatment of thoracoabdominal aortic aneurysms (TAAA).

Technique: Two patients with complex TAAA and high surgical risk were treated with Octafen endograft configuration in a hybrid operating room with computed tomography (CT)-fluoroscopy image fusion guidance, using 3D-3D fusion techniques to facilitate procedural success. The procedure is a modification of the previously-described Octopus technique for endovascular repair of TAAA.

Dynamic Computed Tomography Angiography is More Accurate in Diagnosing Endoleaks than Standard Triphasic Computed Tomography Angiography and Enables Targeted Embolization.

Background: The primary objective was to compare the accuracy of dynamic computed tomography (CT) angiography (d-CTA) with standardized triphasic contrast enhanced CT angiography (t-CTA) in diagnosing endoleak type after endovascular aortic repair (EVAR) using digital subtraction angiography (DSA) as reference standard. The secondary objective was to study the impact of d-CTA on image fusion-guided endoleak embolization.

Methods: A retrospective review of patients who underwent d-CTA imaging after EVAR between March 2019 and July 2021 was performed.

Diagnostic Accuracy of FDG PET for the Identification of Vascular Graft Infection.

Background: Fluorodeoxyglucose (FDG) positron emission tomography (FDG PET/CT) can be used to identify and localize infection in patients with vascular graft infections (VGI). We aimed to evaluate the diagnostic accuracy of 18F-FDG PET/CT by defining thresholds for standardized uptake value (SUV) and tissue-to-background ratio (TBR) that would accurately identify the presence of vascular graft infection.

Methods: Patients with suspected VGI were prospectively recruited and underwent 18F-FDG PET/CT scans.

Multimodality Image-Guided Embolization of Bronchial Artery Pseudoaneurysm in a Patient With Aortopathy.

A 59-year-old man received an incidental diagnosis of a 5-cm right para-aortic mass that was initially thought to be of venous origin. Multimodality imaging revealed a right bronchial artery pseudoaneurysm that was treated with endovascular embolization. Bronchial artery pseudoaneurysms are extremely rare and can be fatal if ruptured.