title: Feasibility and safety of remote endovascular catheter navigation in a porcine model.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of a redesigned remotely operated vascular catheter versus manual catheter manipulation in a porcine model.
  
  
  METHODS
  Following femoral artery puncture and wire insertion, 4 pigs had either a robotically steered catheter (3 animals) or standard manual catheter manipulation to cannulate the contralateral iliac artery, bilateral renal arteries, and the superior mesenteric artery. After harvesting, the vessels were evaluated histologically by an independent laboratory using hematoxylin and eosin staining. Each cannulated artery was assessed for disruption of the intimal surface, intimal thrombus, damage to the tunica muscularis (dissection), mural hemorrhage, and inflammation by a pathologist who was blinded to the technique utilized for cannulation.
  
  
  RESULTS
  No histological evidence of intimal thrombus, disruption, inflammation, or hemorrhage was demonstrated in any vessel section from the robotic cases. In the SMA, 1 of 61 sections from the robotic cases demonstrated mild focal dissection, while 1 of 9 slices from the manual control showed intimal thrombus. Of 129 slices from the renal arteries catheterized by the robotic system, 4 sections demonstrated mild focal dissection, while 2 of 23 sections from the manual control showed grade 1 intimal thrombus. In the iliofemoral arteries, 3 of 91 sections showed mild focal dissection in the robotic cases; in the manual control, 1 of 9 slices demonstrated extensive dissection and another showed mild intimal thrombus.
  
  
  CONCLUSIONS
  The robotically operated catheter was at least as safe as manual manipulation. More extensive injury was actually observed with the manual technique. This newly designed robotic catheter has the potential to offer many advantages in terms of flexibility and range of motion.
authors.affiliation: The Methodist Hospital, DeBakey Heart & Vascular Center, 6550 Fannin, Houston, TX 77030, USA. JBismuth@tmhs.org
authors.forename: Jean
authors.initials: J
authors.lastname: Bismuth
authors.forename: Elika
authors.initials: E
authors.lastname: Kashef
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cheshire
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
mesh_terms: D015901:Angiography, Digital Subtraction; D000818:Animals; D057785:Catheters; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D007083:Iliac Artery / Q000293:injuries; D017538:Mesenteric Artery, Superior / Q000293:injuries; D023421:Models, Animal; D012077:Renal Artery / Q000293:injuries; D018570:Risk Assessment; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation*; D013552:Swine; D057772:Vascular System Injuries / Q000209:etiology / Q000473:pathology / Q000517:prevention & control