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In existing vascular interventional surgical robots, it is difficult to accurately detect the delivery force of the catheter/guidewire at the slave side. Aiming to solve this problem, a real-time force detection system was designed for vascular interventional surgical (VIS) robots based on catheter push force. Firstly, the transfer process of catheter operating forces in the slave end of the interventional robot was analyzed and modeled, and the design principle of the catheter operating force detection system was obtained. Secondly, based on the principle of stress and strain, a torque sensor was designed and integrated into the internal transmission shaft of the slave end of the interventional robot, and a data acquisition and processing system was established. Thirdly, an ATI high-precision torque sensor was used to build the experimental platform, and the designed sensor was tested and calibrated. Finally, sensor test experiments under ideal static/dynamic conditions and simulated catheter delivery tests based on actual human computed tomography (CT) data and vascular model were carried out. The results showed that the average relative detection error of the designed sensor system was 1.26% under ideal static conditions and 1.38% under ideal dynamic stability conditions. The system can detect on-line catheter operation force at high precision, which is of great significance towards improving patient safety in interventional robotic surgery.
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Humans , Catheters , Equipment Design , Mechanical Phenomena , Robotic Surgical Procedures/methods , RoboticsABSTRACT
@#As one of the stimulus-response polymeric intelligent materials, shape memory polymers have been widely applied in biomedicine due to their better biocompatibility, higher controllability, stronger deformation restorability and biodegradability compared with shape memory alloys and shape memory ceramics. This review will introduce the structural principles of shape memory polymers and summarize their applications in the treatment of vascular diseases, especially in endovascular therapy. At the same time, the related technical problems and the future of shape memory polymers are prospected. With the continuous development of processing technology and materials, it can be predicted that shape memory polymers will be more widely used in the medical field.
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Intravascular foreign bodies (IFB), most being iatrogenic foreign bodies, have become common clinical problems because of their adverse effect such as thrombogenesis, which may affect the function of important organs and even lead to death in some serious cases. It is necessary to remove IFB out in time. Percutaneous vascular intervention technologies have been widely used to remove IFB in recent years. The advancements of percutaneous vascular intervention technologies in application of removal IFB were reviewed in this article.
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BACKGROUND: Peripheral arterial disease (PAD) is known as the greatest risk factor affecting the amputation of diabetic foot. Thus, it is crucial to understand the epidemiology of PAD associated with diabetic foot and the relationship between PTA and amputation in predicting prognosis. However, no such multi-year data are available in Korea. Thus, the purpose of this study was to investigate trends of amputation involving diabetic foot based on vascular interventions for PAD in Korea. METHODS: This study was conducted using six-year data obtained from Health Insurance Review and Assessment Service from January 1, 2011 to December 31, 2016. Our study included data pertaining to diabetic foot, PAD, and vascular intervention codes (percutaneous transluminal angioplasty [PTA, M6597], percutaneous intravascular installation of stent-graft [PIISG, M6605], and percutaneous intravascular atherectomy [PIA, M6620]). We analyzed the number of vascular interventions and minor and major amputations each year. The relationship between annual amputation and vascular intervention was analyzed using χ² test. RESULTS: The overall number of vascular interventions increased from 253 (PTA, 111; PIISG, 140; and PIA, 2) in 2011 to 1,230 (PTA, 745; PIISG, 470; and PIA, 15) in 2016. During the same period, the number of minor amputations increased from 2,534 to 3,319 while major amputations decreased from 980 to 956. The proportion of minor amputations among patients who underwent vascular intervention was significantly increased from 19.34% in 2011 to 21.45% in 2016 while the proportion of major amputations among these patients was significantly reduced from 9.88% to 4.27%. In addition, the association between vascular intervention and amputation increased from 0.56 (spearman correlation coefficient) in 2011 to 0.62 in 2016. CONCLUSION: In diabetic foot patients, increase in vascular intervention resulted in a change in amputation pattern, showing statistically significant correlation.
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Humans , Amputation, Surgical , Angioplasty , Atherectomy , Diabetic Foot , Epidemiology , Insurance, Health , Korea , Lower Extremity , Peripheral Arterial Disease , Prognosis , Risk FactorsABSTRACT
Traditional vascular intervention relies on C-arm rotation and use of contrast to obtain imaging,which results in the loss of 3D-image information and increased burden on kidney.Moreover,interventional operators bear higher occupational hazard risk under longtime X-ray exposure and the heavy burden of lead protection apron.Robot-assisted vascular intervention system carries certain advantages,it can significantly reduce the X-ray exposure to operators,obtain precise localization of lesions as well as accurate and stable manipulation.While reducing the contact of the instruments with the vascular wall and the operation tremor,it can improve operator's comfortable sensation.This paper aims to make a detailed summary about the development of robot-assisted vascular intervention system and its clinical application.The future development directions of robot-assisted vascular intervention system is also discussed.
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Objective To investigate effects of early administration of high-dose rosuvastatin(40 mg) on coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary intervention (PCI) for acute myocardial infarction(AMI). Methods Ninety-four consequent AMI patients treated with primary PCI were divided into rosuvastatin group (50 patients) and control group (44 group). The infarct-related artery flow of epicardium was classified in compliance with the TIMI criteria. Myocardial and microvascular perfusion was assessed using the TMPG. The incidence of the MACE and the cytotoxicity and hepatotoxicity of rosuvastatin was respectively recorded in 30 d follow-up period. Results Either patients in the rosuvastatin group or in the control group showed better TMPG immediately after PCI (P<0.05), compared with that before treatment. However, the post-PCI TMPG of the rosuvastatin group was obviously much better than that of control group (P<0.05). Compared with that in control group, the 30-day composite MACE rate was lower in rosuvastatin group and in the TMPG 3 patients of rosuvastatin group:12.0%(6/50) vs. 34.1%(15/44), P<0.05;11.1%(3/27) vs. 42.9%(6/14). There was no cytotoxicity and hepatotoxicity in two groups. Conclusions Early administration of high-dose rosuvastatin (40 mg) can improve coronary microvascular function and short-term outcome in patients treated with primary PCI for AMI, and it is efficient and safety.
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Objective:To investigate the value of 64-slice spiral computed tomography (64SCT) in preoperative evaluation of spinal vascular intervention.Methods: Seventeen patients with spinal vascular malformations(SVM) scheduled for spinal vascular interventional therapy in our hospital between January 2012-December 2014 were collected, all received 64-detector spiral CT angiography (64-MDCTA) before surgery, image postprocessing technologies such as volume rendering (VR), maximum intensity projection(MIP) and multiplanar reconstruction(MPR) were applied to conduct three-dimensional reconstruction, the traveling case of spinal cord feeding artery was analyzed and were compared with DSA test results.Results: All of the 17 patients clearly showed the abnormality of spinal cord blood vessels and lesions scope, the SVM classification and lesions scope were exactly the same as that of DSA and intraoperative performance, the coincidence rate was 100%;1 case of patient was not shown fistula, the rest of the patients clearly shown the draining veins around the spinal cord, open position and flow tendency of radiculomedullary artery, the coincidence rates were 100.00%, 94.12%%, 100.00%.Conclusion: 64-MDCTA is important for SVM patients to preoperative evaluation of spinal vascular intervention, for it can fully and accurately reflect the open position and flow tendency of radiculomedullary artery, spatial relationship with the surrounding vessels, spinal cord and vertebral situation, should be widely applied.
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Objective To investigate the instant clinical efficacy of intra-arterial infusion of fasudil combined with routine anti-vasospasm for symptomatic cerebral vasospasm (SCVS). Methods The clinical data of 21 patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm, who were admitted to authors' hospital during the period from May 2010 and February 2014, were retrospectively analyzed. The lesions included Fisher gradeⅡ(n=2), gradeⅢ (n=16) and gradeⅣ (n=3). Endovascular embolization of the aneurysm was carried out within 48 hours after the confirmation of the diagnosis with total cerebral DSA;no bleeding occurred during the operation and routine anti-vasospasm therapy was given. Within 4-9 days after the onset of the disease, all 21 patients presented SCVS. Half dose systemic heparinization, superselective intra-arterial infusion of fasudil (30 mg fasudil+250 ml saline, lasting for 30 min) were adopted. Reexamination of angiography performed at 15 min after fasudil infusion was employed, and the results were evaluated with NIHSS score by comparing the preoperative findings. Results Imaging examination performed after the treatment showed that significant improvement was obtained in 15 patients and no obvious changes in 6 patients. Clinical symptoms were remarkably improved in 11 patients, partially improved in 4 patients and remained unchanged in 6 patients. The mean NIHSS score was improved from preoperative 28.6 to postoperative 21.2. Conclusion For the treatment of symptomatic cerebral vasospasm, superselective intra-arterial infusion of fasudil is effective and safe, and it has good clinical application value.
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Interventional radiology has lot of advantages in dealing with various emergencies. The technique is minimally-invasive,highly-effective and immediately-efficient,moreover,it integrates the diagnosis with the therapy perfectly. Besides,the interventional techniques applied in emergency medicine include not only the vascular interventions,such as embolization,embolectomy,etc,but also the nonvascular interventions,such as tracheal stent implantation,percutaneous vertebroplasty and so forth. However,importance has not been attached to the clinical use of interventional therapy in emergency medicine so far. It is imperative for us to promote the acceptance of interventional therapy in emergency medicine as well as to popularize the technique in clinical practice.
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Objective To present clinical experience in using StarClose vascular closure device in patients undergoing peripheral vascular interventions. Methods StarClose vascular closure devices were used in 78 patients receiving peripheral vascular interventions in order to close the femoral areriotomies, of which the device was repeatedly used at the same puncture site in 16. Successful hemostasis and vascular complications were observed. Successful hemostasis was defined as the blood oozing completely stopped within 2 min after StarClose deployment, while failure of hemostasis was defined as the blood kept oozing over 2 min after the procedure and manual compression was needed to stop bleeding. Results The mean procedure time for StarClose deployment was (30 ? 10)sec and the mean time for hemostasis was (12 ? 11)sec. Successful rate of hemostasis was 96%, and it was 100% in patients with repeated use of StarClose device. All the patients with successful hemostasis did not need to keep their body still in 2 h. after the surgery. No serious complications occurred. Slight blood oozing was seen in 3 patients 12 h after the procedure. The occurrence of mild complications was 3.2%. Conclusion StarClose vascular closure device can be used to close the femoral puncture site after peripheral vascular interventional procedures with safety and effectiveness, moreover, it can be repeatedly used at the same puncture site.