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Comparison of Outcomes and Radiation Exposure using Fiber-Optic RealShape enabled standard guidewire vs. LumiGuide for Complex Endovascular Aortic Aneurysm Repair
Paula Huertas, Jesus Porras, Andres V. Figueroa, Marilisa Soto - Gonzales, Natalia Coronel, Shadman Baig, Carlos H Timaran
UT Soutwestern, Dallas, TX
Background: Target vessel (TV) cannulation during fenestrated-branched endovascular aortic aneurysm repair (FBEVAR) relies primarily on fluoroscopy. Fiber optic real-time shape (FORS) technology (Philips Medical Systems, Best, Netherlands) uses light refracted through optical fibers to generate real-time renderings of wires and catheters in three-dimensional (3D) space allowing their navigation without radiation. The LumiGuide is an enhanced longer version of the standard guidewire that is coupled with a 3D Hub connector to enhance visualization of commercially available catheters (Figure). This study aims to compare the outcomes and radiation exposure using the standard FORS enabled guidewire vs. the LumiGuide for FBEVAR.
Methods: Data collected from 187 FBEVARs (103 standard FORS, 84 LumiGuide) included 931 TV cannulations (590 with standard FORS and 341 with LumiGuide). Technical success was defined as the successful cannulation of the TVs using only FORS. For both standard FORS and LumiGuide, we compared technical success rates, procedure times, cannulation durations, fluoroscopy times, and cumulative dose-area products (DAP). Welch's t-test was used for continuous variables, while a z-test was applied for proportions.
Results: Patient characteristics did not demonstrate significant differences between groups (Table). FORS technical success was 67% with standard FORS vs. 85% with LumiGuide (P<.001). Compared to standard FORS, the use of LumiGuide resulted in reduced navigation time per TV (6.6 min±11.6 vs 5.3±6.9; P=.05), DAP per TV (5.0±20.2 Gy·cm² vs 3.3±5.2; P=.040), procedure time (241±89 min vs 296±90; P=.01), fluoroscopy time (58±38 min vs 80±40; P=.01) and contrast dose (150±50 mL vs. 130±40; P=.05). Cumulative DAP remained similar between groups (59±38 Gy·cm² for standard FORS vs. 64±43 with LumiGuide; P=.5).
Conclusion: The introduction of LumiGuide and the 3D-Hub for FBEVAR improved FORS technical success and reduced procedure times compared to earlier FORS procedures. The ability to use different commercially available catheters with LumiGuide results in enhanced convenience and lower radiation exposure, thereby improving efficiency and safety.
Demographics and Results| Variable | Standard FORS (Mean ± SD) | LumiGuide (Mean ± SD) | P-value |
| N (BEVAR/FEVAR) | 34/69 | 43/41 | - |
| Age (years) | 71.0 ± 8.0 | 72.0 ± 7.0 | 0.500 |
| Male | 67 (65.0%) | 57 (68.0%) | 0.600 |
| BMI | 28.0 ± 5.0 | 27.0 ± 6.0 | 0.400 |
| Procedure time (min) | 296.4 ± 90.4 | 241.3 ± 88.7 | 0.010 |
| Fluoroscopy time (min) | 80.4 ± 39.9 | 58.5 ± 38.0 | 0.010 |
| Contrast volume (mL) | 150.0 ± 50.0 | 130.0 ± 40.0 | 0.050 |
| DAP (Gy·cm²) | 64.3 ± 43.2 | 58.5 ± 38.0 | 0.500 |
| Navigation time per target(min) | 6.6 ± 11.6 | 5.3 ± 6.9 | 0.050 |
| Fluoroscopy per target (min) | 3.3 ± 5.2 | 2.4 ± 3.8 | 0.030 |
| DAP per target (Gy·cm²) | 5.0 ± 20.2 | 3.3 ± 5.2 | 0.040 |
| FORS only usage (%) | 66.9 | 85.0 | <0.001 |
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