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A major challenge during endovascular interventions is visualising the position and orientation of the catheter being inserted. This is typically achieved by intermittent X-ray imaging. Since the radiation exposure to the surgeon is considerable, it is desirable to reduce X-ray exposure to the bare minimum needed. Additionally, transferring two-dimensional (2D) X-ray images to 3D locations is challenging. The authors present the development of a real-time navigation framework, which allows a 3D holographic view of the vascular system without any need of radiation. They extract the patient's surface and vascular tree from pre-operative computed tomography data and register it to the patient using a magnetic tracking system. The system was evaluated on an anthropomorphic full-body phantom by experienced clinicians using a four-point questionnaire. The average score of the system (maximum of 20) was found to be 17.5. The authors’ approach shows great potential to improve the workflow for endovascular procedures, by simultaneously reducing X-ray exposure. It will also improve the learning curve and help novices to more quickly master the required skills.

Budd–Chiari syndrome (BCS) is an uncommon condition, caused by obstruction to hepatic venous outflow. It is largely underdiagnosed, and a high index of suspicion is required for any patient with unexplained portal hypertension. The understanding of its etiology and pathology is improving with advances in diagnostic techniques. Recent studies reported an identifiable etiology in > 80% of cases. Myeloproliferative neoplasm (MPN) is the most common etiology, and genetic studies help in diagnosing latent MPN. Better cross-sectional imaging helps delineate the site of obstruction accurately. The majority of BCS patients are now treated by endovascular intervention and anticoagulation which have improved survival in this disease. Angioplasty of hepatic veins/inferior vena cava remains under-utilized at present. While surgical porto-systemic shunts are no longer done for BCS, liver transplantation is reserved for select indications. Some of the unresolved issues in the current management of BCS are also discussed in this review.

Peripheral artery disease (PAD) remains one of the leading causes of atherosclerotic cardiovascular diseases affecting millions of people worldwide. Clinical presentation ranges from asymptomatic disease to chronic limb-threatening ischemia, and patients are not only at a higher risk of amputation and limb loss but also at increased risk of cardiovascular events and mortality. Nowadays, many physicians from various specialties are involved in the care of patients with PAD and provide a wide range of vascular interventions and procedures, but to date, there is still a huge discrepancy as to how these patients are managed and followed up after their interventions. This review aims to provide a comprehensive road map for physicians to help them administer a more standardized care covering all aspects of management of patients with PAD in the postintervention phase based on our institution’s best-practice approach.

Autonomous navigation of catheters and guidewires in endovascular interventional surgery can decrease operation times, improve decision-making during surgery, and reduce operator radiation exposure while increasing access to treatment. To determine from recent literature, through a systematic review, the impact, challenges, and opportunities artificial intelligence (AI) has for the autonomous navigation of catheters and guidewires for endovascular interventions. PubMed and IEEEXplore databases were searched to identify reports of AI applied to autonomous navigation methods in endovascular interventional surgery. Eligibility criteria included studies investigating the use of AI in enabling the autonomous navigation of catheters/guidewires in endovascular interventions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), articles were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). PROSPERO: CRD42023392259. Four hundred and sixty-two studies fulfilled the search criteria, of which 14 studies were included for analysis. Reinforcement learning (RL) (9/14, 64%) and learning from expert demonstration (7/14, 50%) were used as data-driven models for autonomous navigation. These studies evaluated models on physical phantoms (10/14, 71%) and (4/14, 29%) models. Experiments within or around the blood vessels of the heart were reported by the majority of studies (10/14, 71%), while non-anatomical vessel platforms \"idealized\" for simple navigation were used in three studies (3/14, 21%), and the porcine liver venous system in one study. We observed that risk of bias and poor generalizability were present across studies. No procedures were performed on patients in any of the studies reviewed. Moreover, all studies were limited due to the lack of patient selection criteria, reference standards, and reproducibility, which resulted in a low level of evidence for clinical translation. Despite the potential benefits of AI applied to autonomous navigation of endovascular interventions, the field is in an experimental proof-of-concept stage, with a technology readiness level of 3. We highlight that reference standards with well-identified performance metrics are crucial to allow for comparisons of data-driven algorithms proposed in the years to come. identifier: CRD42023392259.

Cardiovascular diseases (CVDs), including congenital heart diseases (CHD), present significant global health challenges, emphasizing the need for safe and effective treatment modalities. Fluoroscopy‐guided endovascular interventions are widely utilized but raise concerns about ionizing radiation, especially in pediatric cases. Magnetic resonance imaging (MRI) offers a radiation‐free alternative with superior soft tissue visualization and functional insights. However, the lack of compatible instruments remains a major obstacle. An adapted thermal drawing platform that enables low‐cost and rapid prototyping of instruments for MR‐guided endovascular interventions is introduced. This platform is demonstrated through the development of two exemplary catheter systems: a tendon‐driven steerable catheter with helical lumina and an active tracking Tiger‐shaped catheter with an embedded coaxial wire. These catheters exhibit mechanical properties comparable to commercial counterparts and show promising outcomes in both in vitro and in vivo feasibility testing. This scalable thermal drawing platform addresses the limitations of existing manufacturing approaches and facilitates the exploration of diverse designs, potentially accelerating advancements in catheter technologies for MR‐guided cardiovascular interventions. This research presents an adapted thermal drawing platform for cost‐effective and rapid prototyping of catheters for MR‐guided endovascular interventions. The benefits of the proposed platform are demonstrated in the development of advanced catheter systems, exhibiting excellent mechanical properties and MR visibility. Successful in vitro and in vivo testing underscores their potential for advanced cardiovascular procedures under MR guidance.

Background This study investigates the impact of end-stage renal disease (ESRD) on systemic and localized outcomes in peripheral artery disease (PAD) patients following endovascular therapy (EVT), with a focus on major adverse cardiac and cerebrovascular events (MACCEs). Methods This retrospective cohort study included symptomatic PAD patients, categorized by the Rutherford classification, who underwent EVT at a single tertiary medical center from May 2018 to May 2021. Patients were divided into ESRD and non-ESRD groups. A propensity score-matched (PSM) analysis was performed to minimize confounding factors. The primary outcome was the occurrence of MACCEs, while the secondary outcome was the incidence of major adverse limb events (MALEs). Results ESRD patients exhibited significantly worse systemic outcomes, with higher MACCE rates compared to non-ESRD patients in both the entire cohort (79.9% vs. 39.9%; HR: 2.69; 95% CI: 1.80–4.02; p  < 0.001) and the matched cohort (HR: 3.88; 95% CI: 2.30–6.53; p  < 0.001). They also had higher rates of all-cause mortality and myocardial infarction (MI). For localized outcomes, MALEs were more frequent in the ESRD group in the entire cohort (61.0% vs. 34.9%; HR: 1.84; 95% CI: 1.22–2.76; p  < 0.001), but no significant difference was observed in the matched cohort (HR: 1.23; 95% CI: 0.76–1.99; p  = 0.40). ESRD was identified as the sole independent predictor of increased MACCE risk (HR: 2.49; 95% CI: 1.65–3.75; p  < 0.001). Conclusions PAD patients with ESRD face significantly worse systemic outcomes, particularly elevated MACCE rates, after EVT. Preventing MACCEs, especially MI, is essential in this high-risk population. Despite more severe limb conditions, ESRD alone did not significantly increase MALE risk after PSM. Clinical trial number Not applicable.

Improving health status is a primary indication for peripheral endovascular intervention (PVI) for symptomatic peripheral arterial disease. The data informing mid- and long-term changes and predictors of health status following PVI are limited. LIBERTY 360, a prospective, nonrandomized, multicenter study evaluated outcomes in patients undergoing PVI. Health status measures were assessed at 30-days, 1 and 3-years using EQ-VAS (0-100,100 best health) and VascuQol-25 (1-7,7 best health), stratified by claudication (Rutherford 2-3), and chronic limb-threatening ischemia (CLTI, Rutherford 4-6). Multivariable regression identified predictors of health status at 1-year. Repeated measures models were constructed based on patients with available data through 3 years. Outcomes including major adverse events, all-cause death, major amputation/death, target vessel/lesion revascularization, and major adverse limb events (MALE)/post-operative death were reported. Claudication (n = 501, 41.6%) had higher baseline VascuQol total scores (4.3 ± 1.3) compared to CLTI (n = 703, 58.4%) (3.8 ± 1.4). The VascuQol total score improved at 30-days with claudication (5.4 ± 1.3, p < 0.0001) and CLTI (4.7 ± 1.4, p < 0.0001). Baseline EQ-VAS was higher with claudication (68.3 ± 19.7) than with CLTI (63.1 ± 20.1). EQ-VAS improved at 30-days with claudication (74.9 ± 17.9, p < 0.0001) and CLTI (68.6 ± 19.2, p-value:<0.0001). Improvements were maintained through 3-years. Baseline health status, history of PVI, and comorbidities predicted health status after PVI. While major adverse events rates were high at 3-years, this was driven by target vessel/lesion revascularization with high rates of freedom from major amputation, all-cause death, and MALE in both groups. In conclusion, PVI is associated with mid- long-term improvements in health status across peripheral arterial disease severity. Baseline characteristics were associated with health status at 1-year and may inform patient selection.

Purpose Autonomous navigation of catheters and guidewires can enhance endovascular surgery safety and efficacy, reducing procedure times and operator radiation exposure. Integrating tele-operated robotics could widen access to time-sensitive emergency procedures like mechanical thrombectomy (MT). Reinforcement learning (RL) shows potential in endovascular navigation, yet its application encounters challenges without a reward signal. This study explores the viability of autonomous guidewire navigation in MT vasculature using inverse reinforcement learning (IRL) to leverage expert demonstrations. Methods Employing the Simulation Open Framework Architecture (SOFA), this study established a simulation-based training and evaluation environment for MT navigation. We used IRL to infer reward functions from expert behaviour when navigating a guidewire and catheter. We utilized the soft actor-critic algorithm to train models with various reward functions and compared their performance in silico. Results We demonstrated feasibility of navigation using IRL. When evaluating single- versus dual-device (i.e. guidewire versus catheter and guidewire) tracking, both methods achieved high success rates of 95% and 96%, respectively. Dual tracking, however, utilized both devices mimicking an expert. A success rate of 100% and procedure time of 22.6 s were obtained when training with a reward function obtained through ‘reward shaping’. This outperformed a dense reward function (96%, 24.9 s) and an IRL-derived reward function (48%, 59.2 s). Conclusions We have contributed to the advancement of autonomous endovascular intervention navigation, particularly MT, by effectively employing IRL based on demonstrator expertise. The results underscore the potential of using reward shaping to efficiently train models, offering a promising avenue for enhancing the accessibility and precision of MT procedures. We envisage that future research can extend our methodology to diverse anatomical structures to enhance generalizability.

Endovascular techniques have been embraced as a minimally-invasive treatment approach within different disciplines of interventional radiology and cardiology. The current practice of endovascular procedures, however, is limited by a number of factors including exposure to high doses of X-ray radiation, limited 3D imaging, and lack of contact force sensing from the endovascular tools and the vascular anatomy. More recently, advances in steerable catheters and development of master/slave robots have aimed to improve these practices by removing the operator from the radiation source and increasing the precision and stability of catheter motion with added degrees-of-freedom. Despite their increased application and a growing research interest in this area, many such systems have been designed without considering the natural manipulation skills and ergonomic preferences of the operators. Existing studies on tool interactions and natural manipulation skills of the operators are limited. In this manuscript, new technical developments in different aspects of robotic endovascular intervention including catheter instrumentation, intra-operative imaging and navigation techniques, as well as master/slave based robotic catheterization platforms are reviewed. We further address emerging trends and new research opportunities towards more widespread clinical acceptance of robotically assisted endovascular technologies.

To understand anticoagulation therapy in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) after receiving reperfusion treatments in the real world. This retrospective study collected basic clinical data, the initiation time of anticoagulation therapy, treatment plans, and prognosis of AIS patients with AF who underwent intravenous thrombolysis (IVT), and/or endovascular thrombectomy (EVT) from January 2019 to January 2022 in four tertiary hospitals in Jiangxi Province. A multivariate logistic regression analysis was used to analyze the factors influencing anticoagulation therapy in these patients. The reasons for delay or non-initiation of anticoagulation therapy were analyzed by questionnaire. A total of 410 patients met the selection criteria, including 168 (41.0%) in the IVT group, 144 (35.1%) in the EVT group, and 98 (23.9%) in the IVT + EVT group. Initiation of anticoagulation therapy within 14 days post-AIS was found in 175 patients in total (42.7%), which is significantly different in three groups (49.7% in IVT group, 30.3% in EVT group, and 20.0% in IVT + EVT groups, P  < 0.01). Multivariate logistic regression analysis revealed that prior use of antiplatelet drugs was more common in patients receiving early anticoagulation therapy (OR = 0.122, 95% CI 0.065–0.228, P  < 0.01). Patients receiving no anticoagulation had higher-3-days post-reperfusion NIHSS score (OR = 1.109, 95% CI 1.073–1.147, P  < 0.01) and more in-hospital haemorrhagic transformation (OR = 2.572, 95% CI 1.423–4.648, P  < 0.01). Of all patients, 281 had a favorable 90-day prognosis (mRS score 0–2), including 152 (86.9%) in the early anticoagulation group and 129 (54.9%) in the delay anticoagulation group ( P  < 0.01). Postoperative 90-day outcomes included 25 (6.1%) cases of recurrent ischemic stroke ( P  = 0.55) and 27 (6.6%) bleeding events ( P  = 0.32). Early initiation of anticoagulation therapy improves 90-day outcomes in NVAF post-related AIS patients with related AF after receiving reperfusion treatments; however, the initiation of anticoagulation in most patients might be much later than the currently recommended timing in real world.