Comparison of outcomes and radiation exposure using Fiber-Optic RealShape-enabled standard guidewire versus LumiGuide
Paula Huertas1, Jesus Porras-Colon1, Andres Figueroa1
1Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Background:
Target-vessel (TV) catheterization during fenestrated-branched endovascular aortic aneurysm repair (FBEVAR) relies primarily on fluoroscopy. Fiber-Optic RealShape (FORS) technology (Philips Medical Systems) 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. This study aims to compare the outcomes and radiation exposure using the standard FORS-enabled guidewire vs the LumiGuide for F/B-EVAR.
Methods:
Data collected from 218 F/B-EVARs (129 standard FORS, 89 LumiGuide) included 931 TV catheterizations (590 with standard FORS and 341 with LumiGuide). Technical success was defined as the successful catheterization of the TVs using only FORS. FORS and LumiGuide were compared in terms of technical success rates, procedure times, catheterization duration, fluoroscopy times, and cumulative dose-area products (DAP). Welch t-test was used for continuous variables, whereas a z-test was applied for proportions.
Results:
Patient characteristics did not demonstrate significant differences between groups. FORS technical success was 56.2% with standard FORS vs 79.4% with LumiGuide (P < .001). Compared with standard FORS, the use of LumiGuide resulted in nonsignificant reduced navigation time per TV (6.4 ± 7.4 vs 6.7 ± 9.6 minutes; P = .6), DAP per TV (3.2 ± 5.3 vs 3.36 ± 9.3 Gy·cm2; P = .79), and significant reduction in procedure time (257 ± 91 vs 298 ± 100 minutes; P = .002), fluoroscopy time (58 ± 38 vs 80 ± 40 minutes; P = .01), and contrast dose (130 ± 40 vs 150 ± 50 mL; P = .05). Cumulative DAP remained similar between groups (59 ± 38 Gy·cm2 for LumiGuide vs 64 ± 43 Gy·cm2 with standard FORS; P = .5).
Conclusions:
The introduction of LumiGuide and the 3D-Hub for F/B-EVAR improved FORS technical success and reduced procedure times compared with 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.