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Optical Ultrasound Imaging for Endovascular Repair of Abdominal Aortic Aneurysms: A Pilot Study

Little, Callum; Zhang, Shaoyan; Colchester, Richard; Noimark, Sacha; Mathews, Sunish; Zhang, Edward; Beard, Paul; ... Desjardins, Adrien; + view all (2023) Optical Ultrasound Imaging for Endovascular Repair of Abdominal Aortic Aneurysms: A Pilot Study. In: Greenspan, Hayit and Madabhushi, Anant and Mousavi, Parvin and Salcudean, Septimiu and Duncan, James and Syeda-Mahmood, Tanveer and Taylor, Russell, (eds.) Medical Image Computing and Computer Assisted Intervention – MICCAI 2023. (pp. pp. 699-707). Springer: Cham, Switzerland.

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Abstract

An abdominal aortic aneurysm (AAA) is a persistent localized dilatation of the aorta to more than 1.5 times the expected diameter, which may lead to rupture with resultant high mortality. Endovascular repair (EVAR) of AAAs is a minimally invasive procedure that involves the peripheral delivery of one or more covered endografts to the aneurysmal segment, via a catheter-based system. A particularly challenging group of patients to treat are those in which the aneurysmal sac extends proximally to include the origin of the renal arteries (15% of all AAAs). To maintain the patency of renal side branches in these “complex” cases, in situ fenestration (ISF) of endografts during AAA procedures has been proposed. The challenges addressed in this study were a) to develop an endovascular imaging system for visualizing side branches beyond deployed endografts and thereby to determine the locations for ISF; b) to obtain an initial assessment of the clinical utility of this system. Here, all-optical ultrasound (OpUS) imaging with a fiber optic transducer was used for real-time guidance, wherein ultrasonic pulses are generated in nanocomposite coatings via the photoacoustic effect and received optically using a Fabry-Perot cavity. These custom OpUS transducer components were integrated into a steerable sheath (6 Fr) that also included a separate optical fiber for delivering laser pulses for fenestrating the endograft. In an ex-vivo model, it was shown that OpUS imaging extended through the endograft and underlying aortic tissue, and permitted aortic side-branch visualization. During an EVAR procedure in a porcine model in vivo, an aortic side branch was visualized with OpUS imaging after the endograft was deployed and optical fenestration of the stent graft was successfully performed. This study showed that OpUS is a promising modality for guiding EVAR and could find particularly utility with identifying aortic side branches for ISF during treatment of complex AAAs.

Type: Proceedings paper
Title: Optical Ultrasound Imaging for Endovascular Repair of Abdominal Aortic Aneurysms: A Pilot Study
Event: International Conference on Medical Image Computing and Computer-Assisted Intervention: MICCAI 2023
ISBN-13: 978-3-031-43995-7
DOI: 10.1007/978-3-031-43996-4_67
Publisher version: http://dx.doi.org/10.1007/978-3-031-43996-4_67
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Optical ultrasound imaging; abdominal aortic aneurysm; endovascular repair
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10185265
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