The past four decades have witnessed tremendous strides in the evolution of
endovascular devices and techniques. Catheter-based intervention has revolutionized
the management of arterial disease allowing treatment of aortic and peripheral
pathologies via a minimally invasive approach. Despite the exponential advances in
endovascular equipment, devices and techniques, catheter-based endovascular
intervention has certain morphological and technological constraints. Complex patient
anatomy, technological impediments and suboptimal fluoroscopic imaging, can make
endovascular intervention challenging using traditional endovascular means.
Conventional endovascular catheters lack active manoeuvrability of the tip. Manual
control can hinder overall stability and control at key target areas, leading to
significantly prolonged overall procedure and fluoroscopic times. Repeated
instrumentation increases the risk of vessel trauma and distal embolization. More
importantly, guidewire-catheter skills are not necessarily intuitive but must be
developed and are highly dependent on operator skill with long training pathways as a
result.
Recognizing the pressing need to address some of the limitations of standard catheter
technology this thesis aims to evaluate the role of advanced robotic endovascular
catheters in the aortic arch and the visceral segment. Clinical use of this technology is
currently limited to transvenous cardiac mapping and ablation procedures. A
comprehensive pre-clinical comparison and analysis of robotic versus manual catheter
techniques is presented to reveal both their advantages and limitations, with particular emphasis on the potential of robotic catheter technology to reduce the manual skill
required for complex tasks, improve stability at key target areas, reduce the risk of
vessel trauma, embolization and radiation exposure, whilst improving overall operator
performance. The worlds first clinical report of robot-assisted aortic aneurysm repair,
a “proof - of - concept” resulting from this research, is also presented, and the
potential for future advanced applications in order to increase the applicability of
endovascular therapy to a larger cohort of patients discussed.