Early clinical experience with the Magellan Robotic System for endovascular procedures
Sarah M. Wartman, MD, Joie Dunn, MD, Sukgu Han, MD, Fred A. Weaver, MD, MMM, Sung Wan Ham, MD.
University of Southern California, Los Angeles, CA, USA.
OBJECTIVES: The Magellan Robotic System (MRS) is capable of remote catheter/sheath steerability and has been used for a variety of endovascular procedures in select centers in the United States. Potential advantages include precise navigation, sheath stability, and pushability, particularly in patients with challenging anatomy. We report our initial clinical experience with the MRS.
METHODS: Clinical data was collected for all consecutive patients undergoing endovascular interventions using the MRS between 2014 and 2016. Outcomes included technical success and MRS-related complications, both intraoperative and 30-day/in-hospital.
RESULTS: Forty procedures were performed in 38 patients using the MRS. Procedures included aortic (19), peripheral (11), visceral (6), and venous (4) interventions. Procedure type included visceral/renal cannulation and stent delivery during aortic fenestrated/parallel endografting, peripheral angioplasty/stenting, coil embolization for endoleak/aneurysm/pseudoaneurysms, contralateral gate cannulation, visceral angioplasty/stenting, embolization of arteriovenous malformations, and inferior vena cava filter removal. Technical success was achieved in 37 cases (92.5%). There were three technical failures. One failure occurred in a patient s/p EVAR with a hypogastric artery aneurysm who failed prior parallel grafting for hypogastric preservation from the axillary approach. Despite successful robotic catheter access into the hypogastric aneurysm across the EVAR flow divider, wire access into normal distal hypogastric artery was not possible due to occlusive disease. The second was a failed attempt to recanalize an occluded external iliac vein for dialysis access. Third was unsuccessful recanalization of a celiac artery with flush occlusion. There were no MRS-related complications intraoperatively or within the 30-day/in-hospital period.
CONCLUSIONS: The MRS is an adjunctive tool that can be used for endovascular procedures to treat a variety of vascular pathology. Based on this early experience, technical success was achieved in majority of procedures in multiple vascular beds with no MRS-related complications. Robotic catheters/sheaths provide a stable platform for delivery of standard endovascular devices and may be effective particularly in cases with challenging anatomy and prior failed attempts using manual techniques. Further experience is needed to identify appropriate patients and vascular pathology that may benefit from this technology.
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