Modular Robotic Catheters for Endovascular Aneurysm Repair

An endovascular intervention begins with a skilled clinician manually navigating a long, slender wire, called a guidewire, to the target location within the vasculature. Due to factors, such as vessel tortuosity and lack of steerability at the guidewire tip, manual navigation of a guidewire could be challenging, potentially resulting in vessel damage, perforation, dissection, and occlusion, as well as postsurgical complications, such as thrombosis. This work details the development of a handheld actuation mechanism for tendon-driven robotic guidewires by utilizing the aforementioned spooling mechanism. Incorporating the compact spooling mechanism into a handheld device enables clinicians to leverage both motorized guidewire steering and manual rotation and translation, if desired. The proposed device is designed such that, while holding the device, the clinician can execute feeding, rotation, and bending motions for up to 1.5 m of the robotically steerable guidewire using a joystick and momentary switch on the handle. Furthermore, the proposed device is demonstrated through navigation in an anatomically accurate phantom aorta model.

Long-term mortality rates after endovascular aneurysm repair (EVAR) remain elevated due to post-EVAR rupture caused by loss of seal in stent graft sealing zones. Structured CT review using centerline measurements improves detection, but current workflows require manual centerline editing and expert operators. We propose a transformer framework for automated, protocol-driven sealing zone assessment that combines 3D centerline tracking with embedding-based geometric prediction. Two state-of-the-art image-to-graph models are evaluated for aorto-iliac centerline extraction from follow-up CT and for measurement of stent position, vessel diameters, and seal lengths according to EVAR4C protocol. Across the full test set and a challenging no-contrast subset, the proposed fully automatic method outperforms the commercial semi-automatic workflow.

Robot-assisted endovascular intervention can potentially reduce radiation exposure, improve surgeon ergonomics, enable telesurgery, support active assistance and autonomy, and enhance procedural precision. However, existing systems often suffer from limited procedural coverage because constrained patient-side setups, restricted flexibility, and complex instrument exchange hinder clinical workflow integration. This work presents a compact robotic system for endovascular interventions that enables continuous translational and rotational manipulation of standard endovascular instruments. The system consists of two alternating carts with pneumatically actuated membrane grippers integrated into rotating gripper gears. Its top-loading design allows rapid exchange of instruments such as guidewires and catheters without changing the robotic setup. A leader-follower control strategy enables continuous motion despite the finite stroke of each cart. The system was evaluated in motion-tracking experiments with guidewires and catheters and in an in vitro vascular phantom. The motion-tracking experiments showed generally smooth translational and rotational motion profiles. Across all tested guidewire and catheter experiments, the mean relative tracking errors were 3.6% for translational motion and 4.1% for rotational motion. In the vascular phantom, robot-assisted navigation reached the target in most trials, demonstrating the feasibility of the proposed manipulation concept under in vitro conditions. The presented robotic system demonstrates technical feasibility for continuous manipulation of standard endovascular instruments in bench-top and in vitro experiments. The compact top-loading design may ease instrument exchange and clinical workflow integration. Future work will focus on improving gripping performance, actuation speed, force feedback, and evaluation in more clinically realistic settings.