title: The fluoro-less and contrast-less peripheral endovascular intervention: a concept for the future today.
abstract: BACKGROUND
  Percutaneous endovascular revascularization requires fluoroscopic guidance and radiopaque contrast use. This approach becomes problematic, especially in patients with advanced renal disease or allergies to iodinated contrast medium. The direct (exposure) and indirect (lead garment) burden of radiation affects patients and operators alike.
  
  
  OBJECTIVE
  We propose a completely contrast-free, fluoroscopy-free approach to endovascular diagnostic arterial imaging and percutaneous intervention using available technologies, and outline a timeframe for its implementation.
  Ultrasound imaging of the leg creates a roadmap of the vessel and identifies the lesion of interest. Device-based sensors using a low-powered electromagnetic field allow for wiring of the vessel. This is followed by the use of intravascular ultrasonography and near infrared spectroscopy to characterize the lesion dimensions and composition. After completion of the diagnostic phase of the process, the interventional portion with deployment of an angioplasty balloon and/or stent is performed using the electromagnetic field-guided sensors.
  
  
  RESULTS
  The project uses already available technologies.
  This project demonstrates the real potential of performing endovascular peripheral intervention without fluoroscopy or contrast in a practical, user-friendly way with the currently available technology. The prospects in renal function preservation and radiation avoidance for both patients and operators are extremely attractive.
authors.affiliation: Hofstra-North Shore-LIJ School of Medicine at North Shore-LIJ Health System, Manhasset, NY, USA. Electronic address: g.ephrem@gmail.com.
authors.forename: Georges
authors.initials: G
authors.lastname: Ephrem
authors.affiliation: Hofstra-North Shore-LIJ School of Medicine at North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Joe F
authors.initials: JF
authors.lastname: Lau
authors.affiliation: Hofstra-North Shore-LIJ School of Medicine at North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Perwaiz M
authors.initials: PM
authors.lastname: Meraj
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods; D003287:Contrast Media; D057510:Endovascular Procedures / Q000379:methods; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: Contrast; Endovascular; Intervention; Radiation