Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Can J Cardiol. 2022 May;38(5):662-671. doi: 10.1016/j.cjca.2022.02.020. Epub 2022 Feb 28.
There have been significant advancements in endovascular technology over the past decade. Increasingly complex disease processes are being addressed in a less invasive fashion, while still relying on standard 2-dimensional greyscale fluoroscopy imaging to guide the procedures. With the advent of flat-panel detectors as standard on fluoroscopy units and the use of fluoroscopy cone-beam computed tomography, the development of improved imaging tools has occurred that will help improve the imaging modalities used to perform these endovascular procedures. Fusion imaging, the overlay of preoperative 3-dimensional computed tomographic images, helps interventionalists perform endovascular procedures. Building on this technology, improvements in its function and use have occurred with the additional application of artificial intelligence and machine learning, allowing the images to independently accommodate to changes in the visualised anatomy. Corresponding development of navigation systems, allowing for the tracking of endovascular tools within these images by means of either fibre optics or electromagnetic field generators, are looking to improve the accuracy of the procedures while reducing the need for radiation and contrast agents. These tools are making a dramatic change in our ability to perform complex endovascular procedures, and are the future gold standard. Ultimately, these will allow procedures to occur more quickly and more safely.
在过去的十年中，血管内技术取得了重大进展。越来越复杂的疾病过程正在以侵入性较小的方式得到解决，同时仍然依赖于标准的二维灰度透视成像来指导这些程序。随着平板探测器成为透视设备的标准配置，以及使用透视锥形束计算机断层扫描，出现了改进的成像工具，这将有助于改善用于进行这些血管内程序的成像方式。融合成像，即将术前三维计算机断层扫描图像叠加，帮助介入放射学家进行血管内手术。在此基础上，通过人工智能和机器学习的额外应用，提高了其功能和用途，使图像能够独立适应可视化解剖结构的变化。导航系统的相应发展允许通过光纤或电磁场发生器在这些图像中跟踪血管内工具，旨在提高程序的准确性，同时减少对辐射和对比剂的需求。这些工具正在极大地改变我们进行复杂血管内手术的能力，是未来的黄金标准。最终，这些工具将使手术更快、更安全地进行。
