24. Contemporary Outcomes For Autogenous Infrainguinal Bypass In the Endovascular Era

Abstract

Objective: To report our initial experience of using intraoperative C-arm Cone beam CT (DynaCT ) image fusion guidance along with steerable robotic endovascular catheter navigation to facilitate visceral vessel cannulation procedures. Methods: Between October 2012 and August 2014, 11 patients underwent endovascular procedures using DynaCT image fusion technique along with HansenMagellan vascular robotic catheter. All patients had pre-operative contrast enhanced multi-slice CT imaging (MSCT). For case planning, relevant landmarks and centerlines were electronically marked and stored. At the beginning of each procedure, a non-contrast DynaCT was acquired in the hybrid operating room equipped with a flat-panel robotic C-arm angiographic system. Pre-operative images were co-registered to intra-operative DynaCT images using bony structures. Stored landmarks were overlaid on 2D fluoroscopic images as virtual markers. Vascular access and the robotic catheter were setup and performed per standard. Vessel cannulation was attempted based on virtual markers using robotic catheter. The impact of these virtual markers from image fusion on vessel cannulation was evaluated retrospectively. Results: All 14 vessels were cannulated successfully in 11 patients’ attempted using image fusion guidance. Median vessel diameter at origin was 5.1 mm (2.3 to 13mm), while 10/14 vessels had either calcified/stenosed origin from parent vessel, accounting for the range of vessel diameters. 8/14 vessels (57.1%) were cannulated without any contrast injection. Median number of angiograms required before cannulation was 0 (0 2). On qualitative assessment, 11/12 vessels (91.7%) had grade1⁄41 accuracy (guide-wire inside virtual ostial marker). 11/11 vessels had grade1⁄41 accuracy (virtual centerlines that matched with the actual vessel trajectory during cannulation). Conclusion: Our initial experience with using DynaCT image fusion guidance along with steerable endovascular robotic navigation indicates that such strategies enhance intra-operative 2D fluoroscopy and could play a role in reducing contrast agent use therebymaximizing the versatility of endovascular robotic technology.