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

  • Katharina BreiningerEmail author
  • Moritz Hanika
  • Mareike Weule
  • Markus Kowarschik
  • Marcus Pfister
  • Andreas Maier
Original Article



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.


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.


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.


The accuracy and speed of the proposed method allow for use in an intraoperative setting of deformation correction for EVAR.


EVAR Fluoroscopy Guide wire reconstruction Image guidance 



We thank Dr. Giasemi Koutouzi and Dr. Mårten Falkenberg from Sahlgrenska University Hospital, Gothenburg, Sweden, for providing the data and the registration of intraoperative and preoperative scans.

Compliance with ethical standards

Conflict of interest

A. Maier has no conflict of interest to declare. K. Breininger is funded by Siemens Healthcare GmbH. M. Weule and M. Hanika were working students employed by Siemens Healthcare GmbH at the time of this study. M. Pfister and M. Kowarschik are employees of Siemens Healthcare GmbH.

Ethical approval

This study has been performed retrospectively. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the original study.


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Copyright information

© CARS 2019

Authors and Affiliations

  • Katharina Breininger
    • 1
    Email author
  • Moritz Hanika
    • 2
  • Mareike Weule
    • 2
  • Markus Kowarschik
    • 2
  • Marcus Pfister
    • 2
  • Andreas Maier
    • 1
  1. 1.Pattern Recognition LabFriedrich-Alexander-Universität Erlangen-NürnbergErlangenGermany
  2. 2.Siemens Healthcare GmbHForchheimGermany

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