S Condino1,2, R Piazza1,2, R M Viglialoro2, D M Mocellin3, G Turini2,4, R N Berchiolli2,3, F Micheletti5, F Rossi5, R Pini5, V Ferrari1,2, M Ferrari2,3. 1. 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly. 2. 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly. 3. 3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly. 4. 4Computer Science DepartmentKettering UniversityFlintMI48504USA. 5. 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly.
Abstract
Objective: This work aims at providing novel endovascular instrumentation to overcome current technical limitations of in situ endograft fenestration including challenges in targeting the fenestration site under fluoroscopic control and supplying mechanical support during endograft perforation. Technology: Novel electromagnetically trackable instruments were developed to facilitate the navigation of the fenestration device and its stabilization at the target site. In vitro trials were performed to preliminary evaluate the proposed instrumentation for the antegrade in situ fenestration of an aortic endograft, using a laser guidewire designed ad hoc and the sharp end of a commercial endovascular guidewire. Results: In situ fenestration was successfully performed in 22 trials. A total of two laser tools were employed since an over bending of laser guidewire tip, due to its manufacturing, caused the damage of the sensor in the first device used. Conclusions: Preliminary in vitro trials demonstrate the feasibility of the proposed instrumentation which could widespread the procedure for in situ fenestration. The results obtained should be validated performing animal studies. Clinical Impact: The proposed instrumentation has the potential to expand indications for standard endovascular aneurysm repair to cases of acute syndromes.
Objective: This work aims at providing novel endovascular instrumentation to overcome current technical limitations of in situ endograft fenestration including challenges in targeting the fenestration site under fluoroscopic control and supplying mechanical support during endograft perforation. Technology: Novel electromagnetically trackable instruments were developed to facilitate the navigation of the fenestration device and its stabilization at the target site. In vitro trials were performed to preliminary evaluate the proposed instrumentation for the antegrade in situ fenestration of an aortic endograft, using a laser guidewire designed ad hoc and the sharp end of a commercial endovascular guidewire. Results: In situ fenestration was successfully performed in 22 trials. A total of two laser tools were employed since an over bending of laser guidewire tip, due to its manufacturing, caused the damage of the sensor in the first device used. Conclusions: Preliminary in vitro trials demonstrate the feasibility of the proposed instrumentation which could widespread the procedure for in situ fenestration. The results obtained should be validated performing animal studies. Clinical Impact: The proposed instrumentation has the potential to expand indications for standard endovascular aneurysm repair to cases of acute syndromes.
Authors: Sara Condino; Roberta Piazza; Marina Carbone; Jonathan Bath; Nicola Troisi; Mauro Ferrari; Raffaella Berchiolli Journal: Front Surg Date: 2022-08-19