Characterization of Conventional Endovascular Devices in Treatment of Abdominal Aortic Aneurysms

TL;DR

This study systematically compares conventional steerable and non-steerable catheters in EVAR procedures, highlighting their performance differences in various anatomical scenarios and providing insights for device selection.

Contribution

It introduces a systematic method for quantifying endovascular device performance and evaluates the comparative effectiveness of catheter types in complex aneurysm anatomies.

Findings

Steerable catheters perform better in challenging anatomical scenarios.

No significant difference in overall success rates between catheter types.

Segmented analysis shows different performance in central vs. peripheral regions.

Abstract

Abdominal Aortic Aneurysms (AAA) are often repaired through an Endovascular approach known as EVAR. The success and duration of these challenging procedures are primarily attributable to the accuracy and reliability of navigating corresponding interventional devices. This study investigates the performance of conventional non-steerable and steerable catheters in endovascular aneurysm repair (EVAR) procedures, focusing on two primary metrics: reachable workspace and gate cannulation success. We developed two abdominal aortic aneurysm (AAA) phantoms using patient CT images for our experiments. Under X-ray fluoroscopy guidance, the reachable workspace was quantified, and gate cannulation success rates, cannulation time, and fluoroscopy times were recorded for both non-steerable and steerable catheters and were compared. We were unable to observe statistically significant differences between the two catheter types in overall cannulation success rates or fluoroscopy time. However, in challenging anatomical scenarios (particularly a more challenging gate location), the steerable catheter showed statistically significant advantages in success rates and cannulation times. While there were no statistical differences in reachable workspace between non-steerable and steerable catheters when considering the whole aneurysm, segmented analysis showed that the steerable catheter performed better in the central region, and non-steerable catheters performed better in the peripheral region. This study provides a systematic method for quantifying the performance of endovascular devices. The findings suggest that while steerable catheters may offer advantages in complex anatomical conditions, non-steerable catheters are preferable in peripheral areas of the aneurysm. These insights can inform catheter selection in EVAR, potentially influencing device design and clinical practice.