Patient-specific Virtual Reality Rehearsal Prior to EVAR: Influence on Technical and Non-technical Operative Performance

• Technical operative metrics [ Time Frame: during EVAR procedure ] [ Designated as safety issue: Yes ]
  • C-arm positioning for proximal and distal landing zone
  • Fluoroscopy time
  • Number of angiograms
  • Amount of contrast
• Errors occurring during EVAR procedure (Imperial College Error Capture record) [ Time Frame: during EVAR procedure ] [ Designated as safety issue: Yes ]

• Subjective sense of realism of patient-specific rehearsal reported by team members [ Time Frame: immediately after EVAR procedure ] [ Designated as safety issue: No ]
  Subjective sense of realism of patient-specific rehearsal reported by team members (Measurement: questionnaire)
• Team satisfaction [ Time Frame: immediately after EVAR procedure ] [ Designated as safety issue: No ]
  Team satisfaction Measurement: questionnaire
• Any deviation from initial treatment plan [ Time Frame: immediately after EVAR procedure ] [ Designated as safety issue: No ]
• 30 day mortality and morbidity [ Time Frame: within the first 30 days after surgery ] [ Designated as safety issue: Yes ]
• Technical and clinical success rate [ Time Frame: immediately after EVAR procedure ] [ Designated as safety issue: Yes ]
  • Successful access to the arterial system using a remote site
  • Successful deployment of the endoluminal graft with secure proximal and distal fixation
  • Absence of either type I or III endoleak
  • Patent endoluminal graft without significant twist, kinks, or obstruction
• Initial clinical success [ Time Frame: within the first 30 days after surgery ] [ Designated as safety issue: Yes ]

  o Successful deployment of the endovascular device at the intended location, without:

  • Death as a result of aneurysm-related treatment
  • Type I or III endoleak
  • Graft infection or thrombosis
  • Aneurysm expansion (diameter > 5mm)
  • Aneurysm rupture
  • Conversion to open repair
  • Graft dilatation (≥ 20% by diameter)
  • Graft migration
  • Failure of device integrity

Ongoing technological advances, especially in the field of image processing, have refined medical simulations to offer life-like replications of medical and surgical procedures in a variety of specialties. Patient-specific image data are incorporated into these simulations, and transformed into a 3D model. This enables the practitioner and his/her team to perform and practice 'real' cases on a virtual patient prior to performing the real procedure on the actual patient. This new technology has been referred to as 'patient-specific' rehearsal, also 'mission' or 'procedure' rehearsal.

Research has already proven that simulated patient-specific rehearsal of a carotid artery stenting procedure may enhance surgical and team performance.

The PROcedure rehearsal software can now also be used to practice patient-specific endovascular repair of infrarenal aortic aneurysms (EVAR). The ability to rehearse a challenging and complex procedure like EVAR may not only influence device selection based on preoperative planning, but also improve the technical performance of the surgeon/radiologist and the awareness and communication within the entire endovascular team. However, further research is needed to evaluate if this new technology may enhance clinical safety and efficiency, i.e. if patients actually benefit from physicians and team members conducting patient-specific rehearsals of EVAR interventions.

Patients with an infrarenal aortic aneurysm suitable for endovascular exclusion. The suitability for endovascular repair is based upon the physician's decision.

• PROcedure rehearsal
  PROcedure rehearsal performed before real EVAR procedure No intervention
• No PROcedure rehearsal
  no PROcedure rehearsal performed before real EVAR procedure No intervention

Inclusion Criteria:

-infrarenal aortic aneurysm suitable for endovascular exclusion

Exclusion Criteria:

• Adult patients who do not have capacity to consent.
• Previous stent-graft implanted in the abdominal aorta