title: Technical concepts for vascular electromagnetic navigated interventions: aortic in situ fenestration and transjugular intrahepatic porto-systemic shunts.
abstract: This work presents concepts for complex endovascular procedures using electromagnetic navigation technology (EMT). Navigation software interfacing a standard commercially available navigation system was developed, featuring registration, electromagnetic field distortion correction, breathing motion detection and gating, and state-of-the-art 3D imaging post processing. Protocols for endovascularly placed, in-situ fenestrated abdominal aortic stent grafts and an EMT guided transjugular intrahepatic portosystemic shunt (TIPSS) creation have been designed. A dedicated set of interventional devices was developed for each of the procedures: For aortic in-situ fenestration a combination of high-porosity stentgrafts, steerable catheters and electromagnetically navigated guidewires was used, for TIPSS a dual-navigated (sheath and stylet) TIPSS-device was designed and manufactured. The developed devices underwent phantom testing, in preparation for animal experiments to prove the feasibility of the approach. Once established, these systems could aid in performing these challenging interventional radiology procedures, exploiting the unique characteristics of electromagnetic navigation and solving multiple of the problems associated with these interventions being performed under X-ray fluoroscopy, such as lacking real-time 3D information or extensive exposure to ionizing radiation.
authors.forename: Tobias
authors.initials: T
authors.lastname: Penzkofer
authors.forename: Peter
authors.initials: P
authors.lastname: Isfort
authors.forename: Hong-Sik
authors.initials: HS
authors.lastname: Na
authors.forename: Christoph
authors.initials: C
authors.lastname: Wilkmann
authors.forename: Sabine
authors.initials: S
authors.lastname: Osterhues
authors.forename: Andreas
authors.initials: A
authors.lastname: Besting
authors.forename: Christoph
authors.initials: C
authors.lastname: Hänisch
authors.forename: Stefan
authors.initials: S
authors.lastname: Bisplinghoff
authors.forename: Johannes
authors.initials: J
authors.lastname: Jansing
authors.forename: Sylvie
authors.initials: S
authors.lastname: von Werder
authors.forename: Jorge
authors.initials: J
authors.lastname: Gooding
authors.forename: Mathias
authors.initials: M
authors.lastname: de la Fuente
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Mahnken
authors.forename: Catherine
authors.initials: C
authors.lastname: Disselhorst-Klug
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz-Rode
authors.forename: Christiane K
authors.initials: CK
authors.lastname: Kuhl
authors.forename: Philipp
authors.initials: P
authors.lastname: Bruners
mesh_terms: D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002404:Catheterization / Q000295:instrumentation; D002408:Catheters, Indwelling; D004574:Electromagnetic Fields; D057510:Endovascular Procedures / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation* / Q000379:methods; D055617:Micro-Electrical-Mechanical Systems / Q000295:instrumentation; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*