Editor's choice : European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia

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MR-guided endovascular interventions: a comprehensive review on techniques and applications

The magnetic resonance (MR) guidance of endovascular interventions is probably one of the greatest challenges of clinical MR research. MR angiography is not only an imaging tool for the vasculature but can also simultaneously depict high tissue contrast, including the differentiation of the vascular wall and perivascular tissues, as well as vascular function. Several hurdles had to be overcome to allow MR guidance for endovascular interventions. MR hardware and sequence design had to be developed to achieve acceptable patient access and to allow real-time or near real-time imaging. The development of interventional devices, both applicable and safe for MR imaging (MRI), was also mandatory. The subject of this review is to summarize the latest developments in real-time MRI hardware, MRI, visualization tools, interventional devices, endovascular tracking techniques, actual applications and safety issue

Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

Funding Information: On behalf of the Public and Community Oversight Group (PCOG) of the Health Protection Research Unit in Chemical and Radiation Threats and Hazards: Ian Wright; John Phipps; Colette Kelly; Robert Goundry; Eve Smyth; Andrew Wood; Paul Dale (also of the Scottish Environment Protection Agency). On behalf of the Society and College of Radiographers Patient Advisory Group: Lynda Johnson; Philip Plant; Michelle Carmichael – Specialist Senior Staff Nurse Guy's and St Thomas’ NHS Foundation trust.Peer reviewe

Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

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Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review

Biomedical engineering integrates a variety of applied sciences with life sciences to improve human health and reduce the invasiveness of surgical procedures. Technological advances, achieved through biomedical engineering, have contributed to significant improvements in the field of vascular and endovascular surgery. This paper aims to review the most cutting-edge technologies of the last decade involving the use of augmented reality devices and robotic systems in vascular surgery, highlighting benefits and limitations. Accordingly, two distinct literature surveys were conducted through the PubMed database: the first review provides a comprehensive assessment of augmented reality technologies, including the different techniques available for the visualization of virtual content (11 papers revised); the second review collects studies with bioengineering content that highlight the research trend in robotic vascular surgery, excluding works focused only on the clinical use of commercially available robotic systems (15 papers revised). Technological flow is constant and further advances in imaging techniques and hardware components will inevitably bring new tools for a clinical translation of innovative therapeutic strategies in vascular surgery

Patient radiation exposure from embolo-sclerotherapy of peripheral vascular malformations

Objective: Embolo-sclerotherapy (EST) is the mainstay therapy for peripheral vascular malformations which involves the exposure of patients to ionizing radiation. We aimed to analyze the radiation exposure to patients from EST of peripheral vascular malformations over five years in a single specialist center. / Methods: All patients who had EST performed in a single specialist center for peripheral vascular malformations between January 1st 2013 and January 8th 2018 were identified from a prospectively collected database. Data collection included basic demographics, procedure date, anatomical site, type of vascular malformations and procedural details. Radiation exposure, measured in dose-area product (DAP) and fluoroscopy times, of all patients identified to have EST during the period were retrospectively reviewed. Statistical analysis was performed using Mann-Whitney U and Kruskal-Wallis tests for comparison between subgroups. P<0.05 was considered significant. / Results: A total of 237 patients (median age 30 years; range 1 – 73 years) underwent 419 ESTs during the study period. Of these, 61 (25.7%) patients had arteriovenous malformations (AVM) and underwent 140 (33.4%) ESTs. Meanwhile, 176 (74.3%) patients had venous and lymphatic malformations and underwent 279 ESTs (66.6%). Patients with AVMs had a median of 2 procedures (range 1 - 13), compared to a median of 1 (range 1 - 6) for venous and lymphatic malformations within the study period. The median DAP for single and cumulative EST for peripheral vascular malformations were 1.26 Gycm2 (range 0.00 – 698.36 Gycm2) and 1.91 Gycm2 (range 0.00 – 1300.24 Gycm2), respectively. Whereas, the median fluoroscopy time for single and cumulative EST were 19 seconds (range 1 – 3846 seconds) and 30 seconds (range 1 – 5843 seconds), respectively. Significantly higher patient radiation exposure, in DAP and fluoroscopy times, were measured for single and cumulative EST for AVM when compared with venous and lymphatic malformation (both p <0.01; Mann Whitney U). A significant difference in DAP but not fluoroscopy time was found when anatomical areas of vascular malformations were compared. / Conclusions: Patient radiation exposure for EST of peripheral vascular malformations, measured in DAP and fluoroscopy times, appeared to be generally less than those reported for endovascular arterial and deep venous interventions in the literature. However, some patients with peripheral vascular malformations received relatively high radiation doses. Further studies to investigate the risk factors and long-term side-effects of radiation exposure in these patients and strategies to reduce it are required

Translation of Intravascular Optical Ultrasound Imaging

ances in the field of intravascular imaging have provided clinicians with power ful tools to aid in the assessment and treatment of vascular pathology. Optical Ultra sound (OpUS) is an emerging modality with the potential to offer significant bene fits over existing commercial technologies such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). With this paradigm ultrasound (US) is generated using pulsed or modulated light and received by a miniaturised fibre-optic hydrophone (FOH). The US generation is facilitated through the use of engineered optically-absorbing nanocomposite materials. To date pre-clinical benchtop stud ies of OpUS have shown significant promise however further study is needed to facilitate clinical translation. The overall aim of this PhD was to develop a pathway to clinical translation of OpUS, enabled by the development of a catheter-based device capable of high resolution vascular tissue imaging during an in-vivo setting. A forward-viewing OpUS imaging probe was developed using a 400 µm mul timode optical fibre, dip-coated in a multi-walled carbon nanotube-PDMS com posite, paired with a FOH comprising a 125 µm single mode fibre tipped with a Fabry-Perot cavity. With this high US pressures were generated (21.5 MPa at the transducer surface) and broad corresponding bandwidths were achieved (−6 dB of 39.8MHz). Using this probe, OpUS imaging was performed of an ex-vivo human coronary artery. The results demonstrated excellent correspondence, in the detec tion of calcification and lipid infiltration, with IVUS, OCT and histological analysis. A side-viewing OpUS imaging probe, employing a reflective 45 °angle at the dis tal fibre surface, was used to demonstrate rotational B-mode imaging of a vascular structure for the first time. This provided high-resolution imaging (54 µm axial resolution) with deep depth penetration (>10.5 mm). Finally the clinical utility of this technology was demonstrated during an in-vivo endovascular procedure. An OpUS imaging probe, incorporated into an interventional device, allowed guidance of in-situ fenestration of an endograft during a complex abdominal aortic aneurysm repair. Through this work the potential clinical utility of OpUS, to assess pathology and guide vascular intervention, has been demonstrated. These results pave the way for translation of this technology and a first in man study