方法文章

Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound

DOI：

10.3791/64956

⸱

2023年4月21日

 ,  ,  , 
1Department of Vascular Surgery, University Medical Center Utrecht, 2Technical Medicine, University of Twente

本文内容

摘要

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Described here is a stepwise method of combining Fiber Optic RealShape technology and intravascular ultrasound to show the potential of merging both techniques, in view of the reduction of radiation exposure and improvement of navigation tasks and treatment success during an endovascular procedure for the treatment of peripheral arterial disease.

摘要

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Vascular surgeons and interventional radiologists face chronic exposure to low-dose radiation during endovascular procedures, which may impact their health in the long term due to their stochastic effects. The presented case shows the feasibility and efficacy of combining Fiber Optic RealShape (FORS) technology and intravascular ultrasound (IVUS) to reduce operator exposure during the endovascular treatment of obstructive peripheral arterial disease (PAD).

FORS technology enables real-time, three-dimensional visualization of the full shape of guidewires and catheters, embedded with optical fibers that use laser light instead of fluoroscopy. Hereby, radiation exposure is reduced, and spatial perception is improved while navigating during endovascular procedures. IVUS has the capacity to optimally define vessel dimensions. Combining FORS and IVUS in a patient with iliac in-stent restenosis, as shown in this case report, enables passage of the stenosis and pre- and post-percutaneous transluminal angioplasty (PTA) plaque assessment (diameter improvement and morphology), with a minimum dose of radiation and zero contrast agent. The aim of this article is to describe the method of combining FORS and IVUS stepwise, to show the potential of merging both techniques in view of reducing radiation exposure and improving navigation tasks and treatment success during the endovascular procedure for the treatment of PAD.

引言

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Peripheral arterial disease (PAD) is a progressive disease caused by arterial narrowing (stenosis and/or occlusions) and results in reduced blood flow toward the lower extremities. The global prevalence of PAD in the population aged 25 and over was 5.6% in 2015, indicating that about 236 million adults live with PAD worldwide1,2. As the prevalence of PAD increases with age, the number of patients will only increase in the coming years3. In recent decades, there has been a major shift from open to endovascular treatment for PAD. Treatment strategies can include plain old balloon angiopla....

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方案

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The University Medical Center Utrecht Medical Ethics Committee approved the study protocol (METC 18/422), and the patient provided informed consent for the procedure and protocol.

1. Patient screening

  1. Patient inclusion
    1. Ensure that the patient is >18 years old.
    2. Ensure that the patient is symptomatic for PAD and/or ISR.
  2. Patient exclusion
    1. Exclude patients who cannot provide informed consent due to a language barrier or lack of comprehension.

2. Vessel segmentation

  1. For vessel s....

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结果

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The protocol used for the presented case shows the feasibility of combining the FORS technique and IVUS, with the aim to decrease radiation exposure and contrast usage in an endovascular procedure for PAD. The majority of the procedure is performed without X-ray, and zero contrast is used. Passage through the lesion is performed by using FORS (guidewire and catheter) technology. The steps in which the X-ray is used are described in the protocol; four fluoroscopic images (needed for volume and shape registration), changin.......

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讨论

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To our knowledge, this case report is the first to discuss the combination of FORS and IVUS to limit radiation exposure and exclude the use of a contrast agent during endovascular intervention for PAD. The combination of both techniques during the treatment of this specific lesion seems to be safe and feasible. Furthermore, the combination of FORS and IVUS makes it possible to limit radiation exposure (AK = 28.4 mGy; DAP = 7.87 Gy*cm2) and eliminates the use of contrast agents during the procedure. The present.......

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披露

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Philips Medical Systems Netherlands B.V. provided a research grant according to fair market value to the Division of Surgical Specialties of the University Medical Center Utrecht to support the FORS Learn registry. The Division of Surgical specialties of the University Medical Center Utrecht has a research and consultancy agreement with Philips.

材料

本文使用的材料清单
姓名公司目录编号评论
AltaTrack 导管 Berenstein飞利浦医疗系统荷兰有限公司，荷兰贝斯特ATC55080BRN
AltaTrack 对接顶部飞利浦医疗系统荷兰有限公司，荷兰贝斯特
AltaTrack Guidewire飞利浦医疗系统荷兰有限公司，荷兰贝斯特ATG35120A
AltaTrack 手推车医疗系统荷兰 B.V.，Best，荷兰
Armada 8x40mm PTA 球囊Abbott 实验室，伊利诺伊州，美国B2080-40
Azurion X 射线系统Philips Medical Systems Nederland B.V.，Best，荷兰
Core M2 血管系统Philips Medical Systems Nederland B.V.，Best，荷兰400-0100.17
Hi-Torque Command 导丝美国伊利诺伊州雅培实验室2078175
Perclose Proglide美国伊利诺伊州雅培实验室12673-03
Rosen 0.035 不锈钢导丝美国印第安THSCF-35-180-1.5-ROSEN
Visions PV .014P RX 导管飞利浦医疗系统荷兰 BV，荷兰贝斯特014R
飞利浦纳州库克医疗

参考文献

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  1. Song, P., et al. national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. The Lancet. Global Health. 7 (8), e1020-1030 (2019).
  2. Aday, A. W., Matsushita, K.

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