Target Vessel Catheterization With Fiber Optic Realshape Using Upper Extremity vs Transfemoral Access for Fenestrated-Branched Endovascular Aortic Aneurysm Repair

Abstract

The Fiber Optic RealShape (FORS) technology uses pulses of light delivered through specially designed guidewire and catheters that allow the operator to navigate through the vasculature without radiation. Traditionally, and because of length constraints, FORS has been used primarily for transfemoral (TF) access. The purpose of this study is to report the feasibility and benefits of using FORS during fenestrated-branched endovascular aortic aneurysm repair (FBEVAR), including cannulation times of target vessels (TV) and radiation measures comparing upper extremity (UE) (Figure) vs TF access. A single-center retrospective study with prospectively collected data was performed. Patients undergoing FBEVAR with FORS guidance for TV catheterization were included. Custom-made devices, off-the-shelf (TAMBE, tBranch), Zfen, and physician-modified endografts were used. Navigation data was reported per task, including duration, dose area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) required to accomplish each catheterization. The primary end point included technical success, defined as the navigation accomplishment with no need to switch from FORS to conventional fluoroscopy, and overall radiation exposure. During an 11-month period, 74 patients (70.3% male) underwent FBEVAR with FORS, including 50 custom-made devices, 15 physician-modified endografts, 7 tBranch, 1 TAMBE, and 1 Zfen. Among 370 navigation tasks reported, 350 (94.6%) were performed with FORS, including catheterizations for 225 (64.3%) fenestrations, 61 (17.4%) branches, 50 (14.3%) contralateral gates, and 14 (4%) vessels for preemptive embolization or prestenting. Technical success was 90.3%. Mean time required to deem the catheterization as failure was 8.4 ± 5 minutes. FORS guidewires were used for all procedures. UE access, steerable sheath, and FORS catheters were used in 54.3%, 17.7%, and 13.7%, respectively. The median task duration, RAK, DAP, and FT required for TV cannulation were 5 minutes (interquartile range [IQR], 3-7 minutes), 9.4 mGy (IQR, 4.3-23.7 mGy), 1.0 GyCm2 (IQR, 0.4-2.5 GyCm2), and 1.5 minutes (IQR, 0.8-3.2 minutes), respectively. Among 186 UE TV cannulations and 168 TF TV cannulations, the mean RAK was significantly higher for UE access (25.6 mGy vs 12.5 mGy; P < .00). There were no significant differences in DAP, FT, and TV technical success between UE vs TF access. Overall radiation levels are included in the Table. FBEVAR with FORS technology is feasible using both UE and TF access and facilitates target artery catheterization with acceptable technical success and potentially reduced radiation. Further experience is required to optimize the use of FORS during FBEVARTableFiber-Optic RealShape (FORS) procedural data during fenestrated-branched endovascular aortic aneurysm repair (FBEVAR)VariablesProcedures with FORS technology (n = 74)Cannulation technical success316 (90.3)Procedure duration, minutes313 [246.8-380.8]Total DAP, Gycm2179.5 [116.3-232.5]Total RAK, mGy1327.5 [840.4-1872.3]Fluoroscopy time, minutes71.3 [57.5-92.1]Operator radiation, μSv93 [43-178]Fellow radiation, μSv36.5 [17.3-64.8]Circulator nurse radiation, μSv2 [0-4]Scrub tech radiation, μSv4 [1-9]Anesthesia radiation, μSv5 [2-18]Cannulation time, minutes5 [3-7]Cannulations UE183 (57)Cannulations TF168 (47)Cannulations measuresUETFP valueTotal DAP, Gycm21.0 (0.4-2.10)1.5 (0.5-1.5)NSTotal RAK, mGy8.8 (4.7-20.9)10.5 (4-33.5)<.001Fluoroscopy time, minutes1.6 (0.9-3.2)1.5(0.7-1.5)NSCannulation time, minutes5 (3-7)4 (3-8)NSDAP, Dose area product; N, not significant; RAK, reference air kerma; TF, transfemoral; UE, upper extremity.Values are median [interquartile range] or number (%). Open table in a new tab