Augmented reality in vascular and endovascular surgery: a scoping review

Background: Technological advances have transformed vascular intervention over recent decades. In particular, improvements in imaging and data processing have allowed for the development of increasingly complex endovascular and hybrid interventions. Augmented reality (AR) is a subject of growing interest within surgery, with potential to improve clinicians’ understanding of 3D anatomy and aid the processing of real-time information. This paper hopes to elucidate the potential impact of AR technology in the rapidly evolving field of vascular and endovascular surgery. Objective: The aim of this review was to summarise the fundamental concepts of augmented reality technologies, and to conduct a scoping review of the impact of AR and mixed reality within vascular and endovascular surgery. Methods: A systematic search of MEDLINE, Scopus and Embase was performed in accordance with the Preferred Reporting Items on Systematic Reviews and Meta-analysis (PRISMA) guidelines. All studies written in English from inception until 8th of January 2021 were included in the search. Combinations of the following keywords were used in the systematic search string: (‘augmented reality’ OR ‘hololens’ OR ‘image overlay’ OR ‘daqri’ OR ‘magic leap’ OR ‘immersive reality’ OR ‘extended reality’ OR ‘mixed reality’ OR ‘head mounted display’) AND (‘vascular surgery’ OR ‘endovascular’). Studies were selected by a blinded process between two investigators and assessed with data quality tools. Results: AR technologies have had a number of applications across vascular and endovascular surgery. The majority of studies use 3D imaging of CT angiogram-derived images of vascular anatomy to augment the clinicians anatomical understanding during procedures. A wide range of AR technologies have been employed, with ‘heads up’ fusion imaging and AR head-mounted displays being the most commonly clinically applied. AR applications have included guiding open, robotic and endovascular surgery whilst minimising dissection, improving procedural times, and reducing radiation and contrast exposure. Conclusions: AR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. These include reductions in patient risk and operating times, as well as contrast and radiation exposure for radiological interventions. Further technological advances are required to overcome current limitations, including processing capacity and vascular deformation by instrumentation