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Objective:
An endovascular robotic system capable of remote catheter and sheath steerability has been used successfully in a variety of vascular beds in select centers in the United States in recent years. Reported advantages include precise navigation, increased catheter pushability and sheath stability. We present a case demonstrating the use of the Magellan robotic system in the treatment of a saccular renal artery aneurysm located at the renal hilum in a young patient.
Methods:
The procedure was performed in a conventional hybrid suite under local anesthesia and sedation. A 9 Fr introducer sheath is placed in the right common femoral artery. After mounting the robotic catheter and sheath onto the robotic arm, they were introduced into the patient through the 9Fr sheath over a 0.035 glidewire and advanced into aorta. A 50 cm robotic sheath was selected for this procedure. At this point, the operator sits at the remote workstation, away from the radiation source to begin navigation. The glidewire, catheter and sheath were navigated to the pararenal aorta under fluoroscopy. The tip of the robotic catheter and sheath was articulated towards the left renal artery and engaged the left renal artery orifice. A 0.018 glidewire was advanced into the left renal artery and the catheter and sheath was telescoped into the orifice. The tip of robotic catheter was parked at the neck of the renal aneurysm. Microcatheter access was gained into the aneurysm. Multiple detachable coils were deployed into the aneurysm.
Results:
Following coil embolization of the renal artery aneurysm, a completion angiogram showed successful exclusion of the aneurysm with preservation of flow to the lower pole renal parenchyma. Total fluoroscopy time was 12 minutes. Contrast volume was 70 ml. The patient was discharged the next day. The aneurysm remained thrombosed on 3 month follow-up imaging and the patient had become pregnant in the interim.
Conclusion:
The Magellan system introduces robotic technology to the field of endovascular surgery. Robotic catheters/sheaths represent additional tools for the endovascular interventionist, potentially making procedures more efficient with improved technical success particularly in cases with difficult vascular anatomy or when maintenance of sheath stability is critical. Our case demonstrates the successful use of this robotic technology for renal interventions.