Novel diagnostic and imaging techniques in endovascular iliac artery procedures

ABSTRACT

Introduction

Endovascular revascularization has become the preferred treatment for most patients with iliac artery obstructions, with a high rate of clinical and technical success.

Areas covered

This review will describe novel developments in the diagnosis and treatment of iliac artery obstructions including the augmentation of preprocedural imaging with advanced flow models, image fusion techniques, and state-of-the-art device-tracking capabilities.

Expert opinion

The combination of these developments will change the endovascular field within the next 5 years, allowing targeted iliac treatment without the need for radiographic imaging or iodinated contrast media.

KEYWORDS:

• Angiography
• contrast media
• iliac artery disease
• image fusion
• pressure measurement
• radiation dose
• stenosis
• tracking

Article highlights

• In the era of personalized medicine, the preprocedural workup for endovascular iliac procedures should incorporate a targeted and patient-specific treatment plan.

• Intra-arterial pressure measurements remain the golden standard for equivocal iliac stenoses, but in the near future lesion selection could very well be performed on preprocedural imaging using predictive modeling.

• Prospective monitoring of iodinated contrast media usage and dilution should be considered to improve injection protocols and decrease the use of contrast media.

• The use of preprocedurally acquired MRA images for image fusion is feasible and can be considered instead of CTA images.

• Catheter visualization and tracking techniques, in combination with image fusion, will change the current endovascular field in the next 5 to 10 years.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.