Society For Clinical Vascular Surgery

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Rationale and Feasibility of a Novel Second-Generation Robotic-Assisted System for Endovascular Treatment of Peripheral Vascular Disease
Travis J. Vowels, MD, Johnny R. Tomas, AS, RT(R), Rebecca G. Barnes, BS, Alan B. Lumsden, MD.
Houston Methodist Hospital, Houston, TX, USA.

OBJECTIVES: Complex peripheral vascular interventions carry an increased risk of orthopedic complications and radiation-associated occupational hazards for the operator. Endovascular robotic platforms can reduce radiation exposure by 99%, provide more precise lesion measurements, and decrease the amount of time spent wearing a lead apron. The CorPath Vascular Robotic System (Corindus Vascular Robotics) allows the physician to perform interventional procedures remotely in a seated position from a radiation-shielded console. The feasibility and safety of the first-generation CorPath Vascular Robotic System to treat peripheral arterial disease (PAD) was previously demonstrated using a 0.014-inch platform to navigate tibial vessels. No prior studies have assessed the feasibility of treating PAD with a 0.035-inch platform.
METHODS: We assess the practicality of using the second-generation CorPath GRX to treat PAD using a 0.035-inch platform with the ANGIO Mentor ™ Endovascular Simulator (3D Systems, formerly Symbionix) (Figure). The use of 0.035-inch guidewires with the CorPath GRX is off-label and current designs allow for torqueability of selective catheters but not the 0.035-inch guidewire. We selected two simulator cases to demonstrate three common peripheral vascular maneuvers: crossing the aortic bifurcation, crossing a superficial femoral artery (SFA) lesion, and selecting the anterior tibial artery (ATA). We used a 0.035-inch stiff angled GLIDEWIRE (Terumo International Systems) and a 5-French straight-tip catheter to simulate crossing the aortic bifurcation with a universal flush catheter and to simulate crossing an SFA lesion and selecting the ATA with a multipurpose catheter. We performed all three maneuvers three times manually and three times with the CorPath GRX robot.
RESULTS: Success rate of manually crossing the aortic bifurcation and SFA lesion and selecting the ATA was 100%. Success rate of performing the same three maneuvers with robot assistance was also 100%.
CONCLUSIONS: We demonstrate proof of concept using the second-generation CorPath GRX off-label to drive a 0.035-inch guidewire and selective catheter across the aortic bifurcation through an SFA lesion and select the ATA. Efforts are underway to render the robot more compatible with the 0.035-inch platform for expanded use in peripheral vascular procedures.


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