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Non-Fluoroscopic Imaging for Endovascular Surgery

Due to its two-dimensional (2D) nature and the high radiation exposure associated with its use, fluoroscopy is an imperfect solution to endovascular surgery’s need for intraoperative imaging. Adam Beck, MD discusses non-fluoroscopic imaging for endovascular surgery
Non-Fluoroscopic Imaging for Endovascular Surgery
Featuring:
Adam Beck, MD
Dr. Beck earned his medical degree from the UAB School of Medicine, and then completed his general surgery residency training and a surgical oncology research fellowship at the University of Texas-Southwestern Medical Center. He trained in vascular surgery at the Dartmouth-Hitchcock Medical Center and then completed a fellowship in advanced endovascular techniques, including branched and fenestrated endografts for aortic aneurysmal disease, at the University Medical Center of Groningen in The Netherlands. 

Learn more about Adam Beck, MD 

Release Date: January 4, 2022
Expiration Date: January 3, 2025

Disclosure Information:

Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education

Katelyn Hiden
Physician Marketing Manager, UAB Health System

The planners have no commercial affiliations to disclose.

Faculty:
Adam W. Beck, MD, FACS
Director, Division of Vascular Surgery and Endovascular Therapy

Dr. Beck has disclosed the following financial relationships with ineligible companies:

Grants/Research Support/Grants Pending - Cook Medical, Medtronic Inc., W.L. Gore & Associates, Terumo Corp.
Consulting Fee - Cook Medical, CryoLife, Medtronic Inc., Terumo Corp., Philips

All relevant financial relationships have been mitigated. Dr. Beck does not intend to discuss the off-label use of a product. No other speakers, planners or content reviewers (Ronan O'Beirne, EdD and Katelyn Hiden), have any relevant financial relationships with ineligible companies to disclose.

There is no commercial support for this activity.
Transcription:

Melanie Cole (Host): Welcome to UAB MedCast. I'm Melanie Cole, and I invite you to listen as we explore non-fluoroscopic imaging for endovascular surgery. Joining me is Dr. Adam Beck. He's a professor and Director of the Division of Vascular Surgery and Endovascular Therapy at UAB Medicine. Dr. Beck, it's a pleasure to have you join us again today for this very interesting topic. And due to its 2D nature and the high radiation exposure associated with its use, fluoroscopy has really been deemed an imperfect solution to endovascular surgery's need for intraoperative imaging. Can you tell us a little bit about that and the evolution?

Dr Adam Beck: Sure. Thank you for having me. Fluoroscopic imaging is really the only thing that we've had for decades now to perform endovascular procedures. And unfortunately, even though it's a pretty good way to do these procedures, unfortunately, the radiation that we receive as healthcare providers and the radiation to the patients give us some risk from the procedure that really you can't get rid of despite wearing lead in the operating rooms. The lead itself that we use to protect ourselves actually can cause some occupational hazard. It can cause problems with your back or your neck and, when you go home at night, your back hurts because you've been wearing 15 to 30 pounds of lead throughout the day. And there's actually been some changes that have been seen in people's circulating white blood cells just after doing some fluoroscopic imaging. And so there are a number of companies that are trying to look for ways to navigate the vasculature without having to use fluoroscopy or radiation. And one of these is something that we're going to talk about today.

Melanie Cole (Host): Well, then let's talk about that. So UAB Medicine is one of the first in the world to introduce non-fluoroscopic imaging, an innovation that you have called one of the most transformative technologies you've seen. So tell us about this exciting advancement, Dr. Beck.

Dr Adam Beck: So this particular technology is very new. It was just FDA approved this past year. We are one of the first six institutions in the whole world that have had access to it. So we were the third in the United States. What it is is basically a fiberoptic technology that is built into some catheters and wires that allow us to navigate the vasculature and can see where the fiberoptic wires and catheters are on a screen in front of us, similar to fluoroscopy without having to perform fluoroscopy. And so it's actually overlaid upon a three-dimensional image of the patient's arterial anatomy that is imported from a preoperative CT that is done in preparation for the procedure.

The technology is in its first generation. And so there are a lot of exciting things that are going to come in the future. Right now, we have some navigational catheters and wires that we can use along with it. But, in the future, it will become much more expansive and useful in more than just endovascular procedures.

But, right now, we're using it primarily for complex minimally invasive aortic repair for aneurysms that involve the portion of the aorta that has branches to the intestines and kidneys. These aneurysms are called thoracoabdominal aneurysms because of the location into the chest or thorax and the abdomen.

Melanie Cole (Host): Well, thank you for telling us the procedure that you found this to be most beneficial for at this point. Can you give us any studies that have demonstrated that the application of force reduces fluoroscopy time and dose? Tell us about some of the studies that are out there.

Dr Adam Beck: There are some very early studies that have been done very recently. The first institutions that had access to this are in Europe where it was approved earlier and the physicians who participated in the initial development are located. It is without question a way to decrease the amount of fluoroscopy. It doesn't necessarily decrease the time of the operation right now because we're learning how to use it. But most importantly, it decreases the fluoroscopy dose. It also decreases the manipulation that's required of the catheters and wires. And that is a little hard to describe, but the manipulation of those catheters and wires inside the blood vessels can cause injury to the blood vessels or it can dislodge plaques inside of the blood vessels that can go into the kidneys or down the legs and it reduces those complications that can occur as well. We are working on multiple papers that are looking at this very issue. As our experience grows in the United States and Europe, we'll have a lot more data for publication in the future..

Melanie Cole (Host): Dr. Beck, you mentioned the relevance to the staff and physicians certainly occupationally, as you mentioned, wearing the lead all day. But what about the patients? What have they been saying about this? And tell us about some of the outcomes that you've seen.

Dr Adam Beck: Well, we're early in our experience here, but our patients don't really see it, so they don't know much about it. I show this to them and show them the 3D overlay imaging that we do, and they think it's pretty cool, but it is a pretty complicated subject. So it's a lot to take in. But, just like, lasers and robots, this is an exciting new technology. And most of our patients are pretty savvy these days and have done a lot of research before they get to us. And so they're really interested in seeing the new technology. It just kind of blows your mind a little bit that you can see things inside your body without radiation since we're so used to that.

Melanie Cole (Host): Is there a learning curve involved in using this technology?

Dr Adam Beck: There is, but it's not bad because most of the setup of the equipment in the operating room is done by our radiology techs and our nurses. And we already do a lot of 3D overlay imaging in our OR and it's essentially an adjunct to that 3D overlay imaging that we've been very used to using. And so it's a pretty easy system to use, believe it or not. And it kind of hooks into the equipment that we've already used and the computers that we've used in the past. And so, it's fairly simple. The act of using it from my end and using it inside the body, the catheters and wires are very similar to catheters and wires that I've used my whole career. So it makes it pretty easy to use as well.

Melanie Cole (Host): Then Dr. Beck, you mentioned just briefly before, but where do you see this technology going in terms of potential to improve device visualization in other endovascular interventions? What do you see happening with this?

Dr Adam Beck: Well, I think it's going to expand into any kind of procedure where a catheter and wire is used, especially intraarterial procedures. I could see it being used for chemoembolizations for cancer in the liver in particular. I can see it being used for intercranial interventions for aneurysms or arterial venous malformations or anything that's transarterial. Coronary interventions, this would decrease the radiation to our cardiology colleagues significantly once they start using it in the heart. We can use it for lower extremity interventions.

There's a lot of refinement and changes to the catheters and wires that'll need to be done over the coming years to make it applicable to these more common procedures that are done. And then I think there's going to be some really exciting advancements that'll happen as this is blended with some of the really neat 3D imaging that we're doing. There are companies that are working on virtual reality imaging where you can wear goggles on your face and look at the patient and see the inside of the patient basically in virtual reality, and be able to see these catheters and wires moving inside of the patient without even having to look up on a screen. It would almost feel like you're looking inside the patient at your wires. These are things that people are working on. Right now, it seems like science fiction, but I think in 20 years, it'll be fairly commonplace.

Melanie Cole (Host): And I would love for you to come back and tell us as these advancements are made and UAB Medicine is certainly at the forefront of these technologies and research. So wrap it up for us, for other providers, what would you like them to know about referral for non-fluoroscopic imaging for endovascular surgery and why they should look to the experts at UAB Medicine?

Dr Adam Beck: This is obviously exciting technology. And I think the fact that UAB had the foresight to invest in us and be one of the first centers in the world to have this technology is a really great indication of how cutting edge this institution is. And I hope that people will recognize that and will send their patients with complex vascular surgical problems, especially aortic problems to us. I think we've got a really great referral practice now, but our referral practice stretches well outside of the southeast, and we'd like to continue to see it stretch further. And I think these are things that are indications of why people should send their patients to UAB for their care.

Melanie Cole (Host): I agree with you. It's very exciting, incredible technology. And thank you so much for sharing it with us today. A physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST or you can visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. Please always remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.