Endovascular interventions proceeded under contrast agent and radiation sparing using navigation and imaging techniques for holographic visualisation

This review provides an overview to current endovascular techniques which may reduce the amount of contrast agents and radiation exposure to patient and staff. One integral part for the success of endo - vas cular procedures is innovative and improved vascular imaging. A major challenge during these interventions is visualizing the position and orientation of the catheter being inserted. This is typically achieved by intermittent X-ray imaging and contrast agent application. While endovascular techniques are improving, imaging during the procedure is still dependent on contrast agents and X-Rays with their known disadvantages. Looking at current developments towards radiation-free localization of endo vascular tools, the visualization and proper integration of this spatial information will become a key technology. After an extensive literature review of pathophysiology and clinical side effects of contrast agents and radiation exposure, we describe established procedures added with current experimental work to reduce these well known side effects in endovascular procedures. Based on the ALARA-principles modern angiography systems show optimized technical settings to deliver the best image quality at low radiation levels, such as optimal collimation, flat panel detector technology, pulse mode, auto exposure settings, low-dose modes and anti-scatter grids. Carbon dioxide (CO2) angiography, contrast-enhanced ultrasound (CEUS) imaging, appropriate C-arm angulation for optimal visualization have become standard procedures in large vascular centers. Optical fiber technologies combined with navigation techniques, augmented reality and holographic visualization techniques are under current experimental development. These techniques seem to have the potential as a disruptive technology in future endovascular therapy. Advanced image application and upcoming techniques focus contrast agent and radiation exposure and even some show a disruptive character. The navigated visualization of vessels and spatial position and endovascular tools during interventional procedures will probably become a key technology in future.