Updates in Endovascular Procedural Navigation

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.