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Ahmad W, Weidler P, Salem O, Werra U, Majd P, Dorweiler B. Implications of aortic neck dilation following thoracic endovascular aortic repair. J Vasc Surg 2023; 78:1402-1408.e1. [PMID: 37454954 DOI: 10.1016/j.jvs.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This article reports on a retrospective observational study designed to evaluate the incidence, etiology, and clinical implications of aortic neck dilation following thoracic endovascular aortic repair (TEVAR) for aneurysms with landing zones II and III. METHODS The study included 37 patients who underwent TEVAR and had postoperative computed tomography angiography available within 30 days and at least one computed tomography angiography at 1 year postoperatively. The primary end point was proximal aortic dilation (defined as growth ≥5 mm or ≥10% of the original diameter), and secondary end points included annual growth of the aneurysmal sac, device migration, endoleak, and reintervention with additional neck-related adverse events. The measurements taken during follow-up included the maximum diameter of the aneurysm and aortic diameter at various locations relative to the stent graft. RESULTS During follow-up, a significant increase in aortic diameter was observed at the proximal edge of TEVAR. The estimated freedom from 5 mm or 10% proximal aortic neck growth at 1, 2, and 3 years was 81%, 70%, and 65%, respectively. At the proximal edge of TEVAR the type III aortic arch was significantly associated with 5 mm growth during follow-up (P = .047) and this growth (5 mm or 10%) as well as a 10% increase at +20 mm were significantly associated with more aortic-related reinterventions. Moreover, an aortic diameter at the start <36 mm was associated with a greater increase during follow-up (area under curve in receiver operating characteristic >80%; P < .05). CONCLUSIONS The study concludes that proximal aortic dilation after TEVAR is a common and progressive phenomenon, and the management strategies for aortic neck dilation, including surveillance, secondary interventions, and open conversion, should be considered carefully to optimize patient outcomes and improve the long-term success of the procedure.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Paula Weidler
- Department of Vascular and Endovascular Surgery- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Oroa Salem
- Department of Vascular and Endovascular Surgery- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ursula Werra
- Department of Vascular and Endovascular Surgery- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Payman Majd
- Department of Vascular and Endovascular Surgery- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Smorenburg SPM, Lely RJ, Smit-Ockeloen I, Yeung KK, Hoksbergen AWJ. Automated image fusion during endovascular aneurysm repair: a feasibility and accuracy study. Int J Comput Assist Radiol Surg 2023; 18:1533-1541. [PMID: 36719561 PMCID: PMC10363050 DOI: 10.1007/s11548-023-02832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Image fusion merges preoperative computed tomography angiography (CTA) with live fluoroscopy during endovascular procedures to function as an overlay 3D roadmap. However, in most current systems, the registration between imaging modalities is performed manually by vertebral column matching which can be subjective, inaccurate and time consuming depending on experience. Our objective was to evaluate feasibility and accuracy of image-based automated 2D-3D image fusion between preoperative CTA and intraoperative fluoroscopy based on vertebral column matching. METHODS A single-center study with offline procedure data was conducted in 10 consecutive patients which had endovascular aortic repair in which we evaluated unreleased automated fusion software provided by Philips (Best, the Netherlands). Fluoroscopy and digital subtraction angiography images were collected after the procedures and the vertebral column was fused fully automatically. Primary endpoints were feasibility and accuracy of bone alignment (mm). Secondary endpoint was vascular alignment (mm) between the lowest renal artery orifices. Clinical non-inferiority was defined at a mismatch of < 1 mm. RESULTS In total, 87 automated measurements and 40 manual measurements were performed on vertebrae T12-L5 in all 10 patients. Manual correction was needed in 3 of the 10 patients due to incomplete visibility of the vertebral edges in the fluoroscopy image. Median difference between automated fusion and manual fusion was 0.1 mm for bone alignment (p = 0.94). The vascular alignment was 4.9 mm (0.7-17.5 mm) for manual and 5.5 mm (1.0-14.0 mm) for automated fusion. This did not improve, due to the presence of stiff wires and stent graft. CONCLUSION Automated image fusion was feasible when all vertebral edges were visible. Accuracy was non-inferior to manual image fusion regarding bone alignment. Future developments should focus on intraoperative image-based correction of vascular alignment.
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Affiliation(s)
- Stefan P M Smorenburg
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Room J1A-222, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Rutger J Lely
- Department of Radiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Kak Khee Yeung
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Room J1A-222, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arjan W J Hoksbergen
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Room J1A-222, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Colacchio EC, Berton M, Squizzato F, Menegolo M, Piazza M, Grego F, Antonello M. The role of multimodal imaging in emergency vascular conditions: The journey from diagnosis to hybrid operating rooms. Semin Vasc Surg 2023; 36:355-362. [PMID: 37330247 DOI: 10.1053/j.semvascsurg.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Multimodal imaging is the incorporation of two or more imaging modalities during the same examination, and it has both diagnostic and treatment applications. The use of image fusion for intraoperative guidance in endovascular interventions is being extended increasingly to the field of vascular surgery, especially in the context of hybrid operating rooms. The aim of this work was to perform a review and narrative synthesis of the available literature in order to report on current applications of multimodal imaging in diagnosis and treatment of emergent vascular conditions. Of 311 records selected in the initial search, 10 articles were included in the present review: 4 cohort studies and 6 case reports. The authors have presented their experience in treating ruptured abdominal aortic aneurysms; aortic dissections; traumas; standard endovascular aortic aneurysm repair, with or without deterioration of renal function; and complex endovascular aortic aneurysm repair, and reported on the long-term clinical results. Although the current literature about multimodal imaging application in emergency vascular conditions is limited, this review highlights the potential of image fusion in hybrid angio-surgical suites, especially for diagnosing and performing treatment in the same operating room, avoiding patient transfer, and allowing procedures with zero or low-dose contrast mean.
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Affiliation(s)
- Elda Chiara Colacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy.
| | - Mariagiovanna Berton
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Francesco Squizzato
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Mirko Menegolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Michele Piazza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Franco Grego
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Michele Antonello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Via Nicolò Giustiniani 2, 35128 Padova, Italy
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Ahmad W, Brunkwall J, Bunck AC, Dorweiler B, Mylonas S. Favorable Remodeling After TEVAR in Uncomplicated Acute and Subacute Type B Aortic Dissection in Comparison to Conservative Treatment: A Midterm Analysis. J Endovasc Ther 2023:15266028231158971. [PMID: 36891635 DOI: 10.1177/15266028231158971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the midterm and long-term outcomes of patients who underwent thoracic endovascular aortic repair (TEVAR) procedure to treat an uncomplicated acute and subacute type B aortic dissection (uATBAD) with high risk for subsequent aortic complications compared with the group of patients who received a conservative treatment protocol during the same period. MATERIALS AND METHODS Between 2008 and 2019, 35 patients who had TEVAR due to uATBAD and those with conservative procedure (n=18) were included in a retrospective analysis and follow-up study. The primary endpoints were false lumen thrombosis/perfusion, true lumen diameter, and aortic dilatation. The aortic-related mortality, reintervention, and long-term survival were the secondary endpoints. RESULTS In the study period, 53 patients (22 females) with a mean age of 61.1±13 years were included. No 30-day and in-hospital mortality was recorded. Permanent neurological deficits occurred in 2 patients (5.7%). In the TEVAR group (n=35) and in a median follow-up period of 34 months, a significant reduction of maximum aortic and false lumen diameter as well as a significant increase of true lumen diameter were detected (p<0.001 each). Complete false lumen thrombosis increased from 6% preoperatively to 60% at follow-up. The median difference in aortic, false lumen, and true lumen diameter was -5 mm (interquartile range [IQR]=-28 to 8 mm), -11 mm (IQR=-53 to 10 mm), and 7 mm (IQR=-13 to 17 mm), respectively. In 3 patients (8.6%), a reintervention was needed. Two patients (1 aortic-related) died during follow-up. The estimated survival according to Kaplan-Meyer analysis was 94.1% after 3 years and 87.5% after 5 years. Similar to the TEVAR group, no 30-day or in-hospital mortality was recorded in the conservative group. During follow-up, 2 patients died and 5 patients underwent conversion-TEVAR (28%). In a median follow-up period of 26 months (range=150), a significant increase of maximum aortic diameter (p=0.006) and a tendency to augmentation of the false lumen (p=0.06) were noted. No significant reduction of the true lumen was seen. CONCLUSIONS Thoracic endovascular aortic repair in patients at high risk of subsequent aortic complications in uncomplicated acute and subacute type B aortic dissection is safe and is associated with favorable midterm outcomes regarding aortic remodeling. CLINICAL IMPACT In a retrospective, single center analysis of prospectively collected data with follow-up, we compared 35 patients with high-risk features who recieved TEVAR in acute and sub-acute uncomplicated type B aortic dissection to a control-group (n=18). The TEVAR group showed a significant positive remoduling (reduction of max. aortic and false lumen diameter and increase of true lumen diameter (p<0.001 each)) during follow-up with an estimated survival of 94.1% after 3 years and 87.5% after 5 years.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Klaassen J, Vijn LJ, Hazenberg CEVB, van Herwaarden JA. New tools to reduce radiation exposure during aortic endovascular procedures. Expert Rev Cardiovasc Ther 2022; 20:567-580. [PMID: 35726665 DOI: 10.1080/14779072.2022.2092096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The evolution of endovascular surgery over the past 30 years has made it possible to treat increasingly complex vascular pathologies with an endovascular method. Although this generally speeds up the patient's recovery, the risks of health problems caused by long-term exposure to radioactive radiation increase. This warrants the demand for radiation-reducing tools to reduce radiation exposure during these procedures. AREAS COVERED For this systematic review Pubmed, Embase and Cochrane library databases were searched on 28 December 2021 to provide an overview of tools that are currently used or have the potential to contribute to reducing radiation exposure during endovascular aortic procedures. In addition, an overview is presented of radiation characteristics of clinical studies comparing a (potential) radiation-reducing device with conventional fluoroscopy use. EXPERT OPINION Radiation-reducing instruments such as fiber optic shape sensing or electromagnetic tracking devices offer the possibility to further reduce or even eliminate the use of radiation during endovascular procedures. In an era of increasing endovascular interventional complexity and awareness of the health risks of long-term radiation exposure, the use of these technologies could have a major impact on an ongoing challenge to move toward radiation-free endovascular surgery.
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Affiliation(s)
- Jurre Klaassen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linde J Vijn
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Massiot N, Ben Abdallah I, Duprey A, Leygnac S, Corcos O, Castier Y, El Batti S. Multicentre Evaluation of an Extra Low Dose Protocol to Reduce Radiation Exposure in Superior Mesenteric Artery Stenting. Eur J Vasc Endovasc Surg 2020; 60:925-931. [DOI: 10.1016/j.ejvs.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 07/10/2020] [Accepted: 08/03/2020] [Indexed: 02/02/2023]
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Nikol S, Mathias K, Olinic DM, Blinc A, Espinola-Klein C. Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review. VASA 2020; 49:1-36. [PMID: 32856993 DOI: 10.1024/0301-1526/a000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
More than 6,000 publications were found in PubMed concerning aneurysms and dissections, including those Epub ahead of print in 2019, printed in 2020. Among those publications 327 were selected and considered of particular interest.
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Affiliation(s)
- Sigrid Nikol
- Department of Angiology, ASKLEPIOS Klinik St. Georg, Hamburg, Germany.,University of Münster, Germany
| | - Klaus Mathias
- World Federation for Interventional Stroke Treatment (WIST), Hamburg, Germany
| | - Dan Mircea Olinic
- Medical Clinic No. 1, University of Medicine and Pharmacy and Interventional Cardiology Department, Emergency Hospital, Cluj-Napoca, Romania
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
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Lovato L, Cefarelli M, Gatta E, Di Eusanio M, Fattori R. Devices for thoracic endovascular aortic repair of type B aortic dissection: is there any chance for Marfan syndrome? Expert Rev Med Devices 2020; 17:683-696. [DOI: 10.1080/17434440.2020.1782735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardiovascular Radiology Unit and Marfan Center; S.Orsola-Malpighi Hospital; University of Bologna, Italy
| | - Mariano Cefarelli
- Cardiovascular Department, Cardiac Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Emanuele Gatta
- Cardiovascular Department, Vascular Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Ancona, Italy
| | - Marco Di Eusanio
- Cardiovascular Department, Cardiac Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rossella Fattori
- Cardiovascular Department, Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Spanos K, Panuccio G, Rohlffs F, Heidemann F, Tsilimparis N, Kölbel T. Technical Aspects of Branched Thoracic Arch Graft Implantation for Aortic Arch Pathologies. J Endovasc Ther 2020; 27:792-800. [PMID: 32431247 DOI: 10.1177/1526602820925443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the implantation steps and tips and tricks for the Inner Branch Arch Endograft designed to treat aortic arch aneurysm and chronic type A aortic dissection. TECHNIQUE Anatomical suitability criteria should be met in order to use this device. The proximal segment of the graft lands in the ascending aorta distally to the sinotubular junction and the distal segment lands in the descending aorta. The device includes 2 inner branches; the proximal branch is used for a connection to the innominate artery (positioned slightly posterior at 12:30 o'clock), while the second branch is positioned slightly anterior at 11:30 o'clock and is used as a connection to the left common carotid artery. Access, implantation technique, deployment of the device, and catheterization of the branches are described thoroughly. CONCLUSION This Inner Branch Arch Endograft is an appealing alternative to treat aortic arch pathology, especially in patients unsuitable for open repair. Nevertheless, complex aortic arch repair is associated with a learning curve. Meticulous preoperative planning and a high level of concentration intraoperatively are mandatory.
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Affiliation(s)
- Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Heidemann
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Constrained stochastic state estimation of deformable 1D objects: Application to single-view 3D reconstruction of catheters with radio-opaque markers. Comput Med Imaging Graph 2020; 81:101702. [PMID: 32193055 DOI: 10.1016/j.compmedimag.2020.101702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/21/2022]
Abstract
Minimally invasive fluoroscopy-based procedures are the gold standard for diagnosis and treatment of various pathologies of the cardiovascular system. This kind of procedures imply for the clinicians to infer the 3D shape of the device from 2D images, which is known to be an ill-posed problem. In this paper we present a method to reconstruct the 3D shape of the interventional device, with the aim of improving the navigation. The method combines a physics-based simulation with non-linear Bayesian filter. Whereas the physics-based model provides a prediction of the shape of the device navigating within the blood vessels (taking into account non-linear interactions between the catheter and the surrounding anatomy), an Unscented Kalman Filter is used to correct the navigation model using 2D image features as external observations. The proposed framework has been evaluated on both synthetic and real data, under different model parameterizations, filter parameters tuning and external observations data-sets. Comparing the reconstructed 3D shape with a known ground truth, for the synthetic data-set, we obtained average values for 3D Hausdorff Distance of 0.81±0.53mm, for the 3D mean distance at the segment of 0.37±0.17mm and an average 3D tip error of 0.24±0.13mm. For the real data-set,we obtained an average 3D Hausdorff distance of 1.74±0.77mm, a average 3D mean distance at the distal segment of 0.91±0.14mm, an average 3D error on the tip of 0.53±0.09mm. These results show the ability of our method to retrieve the 3D shape of the device, under a variety of filter parameterizations and challenging conditions: uncertainties on model parameterization, ambiguous views and non-linear complex phenomena such as stick and slip motions.
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