AortaScope
Precise Endovascular Navigation & Implant Alignment
Introduction
The aorta, the body's largest artery, carries blood from the heart to major organ systems. However, it is prone to several mechanical issues, including, aortic aneurysms (a swelling or dilation of the aorta), aortic dissections (a separation of the layers within the aortic wall), and aortic valve stenosis – a narrowing caused by valve calcification, restricting blood flow from the heart. Minimally invasive aortic surgery is preferred over open surgery due to its faster recovery, lower risk of complications, and reduced invasiveness. These procedures involve inserting catheters into the aorta through the femoral artery (near the groin), allowing interventionalists to navigate surgical tools and place endovascular grafts, stents, and valves with precision.
Problem
Current imaging modalities for endovascular aortic procedures present significant limitations. Fluoroscopy (a type of x-ray), the is the most widely used method and provides only a 2D projection of the torso, where the aortic vasculature cannot be easily distinguished from other soft structures in the body due to low contrast. Additionally, fluoroscopy exposes both the surgeon and patient to harmful ionizing radiation. Intravascular ultrasound (IVUS) offers cross-sectional imaging of the vessel though does not provide real-time 3D positional awareness of the interventional tool. Preoperative image registration can aid in navigation, but the process requires the surgeon to manually register the aorta to sparse anatomical landmarks in 2D fluoroscopic views. Additionally, preoperative imaging does not represent the intraoperative shape of the vessel, which may change due to diseases progression or interaction with surgical tooling.
The lack of real-time 3D awareness during these procedures increases the risk of postoperative complications such as endoleaks (EVAR) or paravalvular leakage (TAVR). Additionally, branch occlusion can occur due to poor alignment of the implant's fenestrations (i.e., openings) that maintain the patency of the patient’s vasculature (e.g., the abdominal arteries in fenestrated EVAR or the coronary arteries in TAVR), increasing the risk of end organ ischemia. These challenges highlight the need for an improved 3D guidance system that enhances spatial understanding while minimizing radiation exposure and procedural errors.
Opportunity
Our proposed solution is a platform for ultrasound-driven augmented reality to enhance minimally invasive endovascular surgery. It integrates intravascular ultrasound (IVUS), position tracking, and preoperative imaging to generate real-time 3D visualizations of the aorta, improving procedural guidance for interventions such as endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR). The system features a hybrid catheter combining IVUS and position sensing (e.g., electromagnetic tracking, fiber optic shape sensing). A keypoint-driven non-rigid registration algorithm fuses the IVUS-based 3D reconstruction with preoperative CT or MRI, correcting for variations due to disease progression, posture changes, or intraoperative deformation. A key feature of the platform is real-time implant deployment prediction, allowing clinicians to visualize and align EVAR grafts, TAVR valves, and guidewires in real time. A simulated endoscopic view provides a lumen-based visualization of vascular structures, improving procedural accuracy.