Endovascular biometrics and engineering

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Abstract


Aim. To study technical problems in the provision of endovascular care and to develop technological solutions for its improvement based on endovascular biometry.

Methods. For the period 2015–2019 an expert analysis of the results of endovascular treatment of 1546 patients with chronic lower limb ischemia was performed, in which it was not possible to perform lower limb revascularization according to the standard method using a guide catheter, guidewire and balloon catheter. The expert group inclu­ded 5 interventional radiologists who performed endovascular procedures. The results were assessed by the effectiveness of revascularization using the developed innovative technology from a system of catheters of various diameters and stiffness in comparison with the results of using standard endovascular technique. Calculation of adequate statistical indicators and their reliability were undertaken using Statistica software (version 6.0).

Results. The “critical” and “weak” zones of the vascular bed were identified for the first time to substantiate the development of a technology for safe and effective endovascular revascularization. It has been established that technical difficulties in catheterization of vessels create the prevalence of atherosclerotic lesions and the limited technical capabilities of catheters and guidewires, which are manipulated under the conditions of increasing high friction with the vessel wall caused by tortuosity and atherosclerosis, the presence of “weak” and “critical” zones of the blood vessels, as well as a significant distance from the surgeon's hands to the area of medical manipulation, ­reaching 130–200 cm. The developed innovative design from the catheter system ensured the effectiveness of endovascular lower limb revascularization in all patients (100%) using the femoral and brachial accesses compare to the standard technique of endovascular care (p <0.001).

Conclusion. Endovascular instruments offered on the domestic market do not guarantee the effective completion of revascularization. The technology of vascular catheterization developed based on endovascular biometry ensures the successful completion of revascularization in 100% of cases.


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About the authors

Roman S Goloshchapov-Aksenov

Central Clinical Hospital of OJSC "Russian Railways"; Peoples' Friendship University in Russia

Author for correspondence.
Email: mzmo-endovascular@mail.ru

Russian Federation, Moscow, Russia; Moscow, Russia

Dmitry Kicha

Peoples' Friendship University in Russia

Email: mzmo-endovascular@mail.ru

Russian Federation, Moscow, Russia

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Supplementary files

Supplementary Files Action
1.
Fig. 1. The scheme of the left common iliac artery cathete­rization through the right brachial arteria— 1. “Critical” zone in the site where the aortic arch gives rise to the brach iocephalic trunk — 2. “Critical” zone in the site of the transition of the aortic arch into the descending part of the thoracic aorta — 3. A catheter formed in a loop with a diameter of 2.7 mm in the “Weak” zone of transition of the ascending part of the thoracic aorta to the aortic arch, with a diameter of 28 mm — 4

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2.
Fig. 2. The scheme of catheterization of arteries of the left lower limb through the right arterial femoral approach — 1. “Critical” zone in the lower wall of the abdominal aortic bifurcation — 2. Catheter formed in a loop with a diameter of 2.7 in the “Weak” zone in the area of bifurcation of the abdominal aorta with a diameter of 19 mm — 3

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3.
Fig. 3. Computer angiogram of the arteries of the lower extre­mities of a patient with ­chronic cri­tical ischemia of the left ­lower limb. Stenosis of the left common iliac artery 80% (1), left external iliac artery 95% (2), left superficial femoral artery 95% (3) and proximal occlusion of the ti­bial and fibular arteries(4), stenosis of the proximal right common iliac artery 70% (5)

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4.
Fig. 4. A bioengineered design of three catheters of various modifications, diameters and lengths, mounted in each other and a Y-connector and a guide for safe and effective advancement through the atherosclerotic vascular bed, tortuosity and angulation of arteries: 1 — the site of puncture and catheterization of the right common femoral artery; 2 — single-layer polyethy­lene catheter-introducer 6 French sheath 45 cm length; 3 — conductive multilayer thin-walled reinforced catheter 6 French sheath 100 cm length; 4 — Y-connector; 5 — non-reinforced multilayer catheter with hydrophilic coating 5 French 125 cm length; 6 — metal guidewire (diameter 0.035 inches)

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© 2020 Goloshchapov-Aksenov R.S., Kicha D.

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