Simultaneous reconstruction of multiple stiff wires from a single X-ray projection for endovascular aortic repair.

Purpose: Endovascular repair of aortic aneurysms (EVAR) can be supported by fusing pre- and intraoperative data to allow for improved navigation and to reduce the amount of contrast agent needed during the intervention. However, stiff wires and delivery devices can deform the vasculature severely, which reduces the accuracy of the fusion. Knowledge about the 3D position of the inserted instruments can help to transfer these deformations to the preoperative information.
Method: We propose a method to simultaneously reconstruct the stiff wires in both iliac arteries based on only a single monoplane acquisition, thereby avoiding interference with the clinical workflow. In the available X-ray projection, the 2D course of the wire is extracted. Then, a virtual second view of each wire orthogonal to the real projection is estimated using the preoperative vessel anatomy from a computed tomography angiography as prior information. Based on the real and virtual 2D wire courses, the wires can then be reconstructed in 3D using epipolar geometry.
Results: We achieve a mean modified Hausdorff distance of 4.2 mm between the estimated 3D position and the true wire course for the contralateral side and 4.5 mm for the ipsilateral side.
Conclusion: The accuracy and speed of the proposed method allow for use in an intraoperative setting of deformation correction for EVAR.