“I think this represents the beginning of the end of an era where we have to use lead to perform these procedures.” Those were the words delivered by Gustavo Oderich, MD, professor and chief of vascular and endovascular surgery at UTHealth’s McGovern Medical School in Houston, as he demonstrated the results of an ex vivo experiment in which the emerging Intra-Operative Positioning System (IOPS) imaging technology was used “totally radiation-free.”
Oderich was speaking during the 2021 VEITHsymposium (Nov. 16-20) in Orlando, Florida. He was displaying for the audience how he and colleagues used a 3D-printed aortic model, and performed a complex endovascular aneurysm repair (EVAR) on an abdominal aortic aneurysm (AAA) using the 3D, GPS-like surgical navigation tool, or electromagnetic image guidance.
“We’re all aware of the deleterious effects of ionizing radiation, particularly for complex endovascular procedures,” Oderich—a member of the scientific advisory board of the Centerline Biomedical, the company behind IOPS—told VEITH 2021 delegates, pointing to data suggesting that exposure to radiation is 3-to-15 times greater during fenestrated-EVAR as during a standard EVAR procedure.
Oderich detailed how he and colleagues deployed IOPS during the experiment, hooking up a tracking system to the operating table alongside wires and catheters integrated with sensors—with capabilities not only to show the vascular anatomy but also multiple devices, explained Oderich. The research team printed the anatomy of an aortic aneurysm and obtained computed tomography (CT) angiography of the model in order to create a map for the use of IOPS. The team proceeded to a hybrid operating room, performed an EVAR on the 3D model—connected to a fluid pump—and deployed a sensorized bifurcated stent graft. The major caveat being, explained Oderich, “we did not use fluoroscopy but IOPS.”
Displaying outtakes from the procedure, Oderich pointed out the positioning of sensors on the bifurcated device, with positions at the top and also in the contralateral gate and the ipsilateral limb. Oderich went on to outline catheterization of the lowest renal artery and advancement of the device.
“You can see one of the potential benefits of this imaging is how it allows you to see multiple dimensions—including from the bottom, which is the ideal view for us to cannulate a gate,” he said. Intravascular ultrasound (IVUS) was also deployed in order to demonstrate “that the wire was indeed in the central lumen portion of the stent graft.”
After the procedure, a contrast CT was carried out in order to demonstrate proof of concept. “I want you to see how close we were from the target, which was the left, lowest renal artery, which was approximately a millimeter or two,” Oderich added. “This procedure allowed us to do precise dilatation not using any lead, no fluoroscopy.”