Artis zeego system

Manufactured by Siemens

Sourced in Germany

The Artis Zeego system is a versatile, ceiling-mounted angiography system developed by Siemens. The system provides high-quality imaging capabilities for interventional and surgical procedures. It features a multi-axis robotic C-arm design that allows for a wide range of positioning options.

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Lab products found in correlation

Visipaque 270, by GE Healthcare (1 mentions) Acuson s3000, by Siemens (1 mentions) Sapien xt, by Edwards Lifesciences (1 mentions) Sapien 3, by Edwards Lifesciences (1 mentions) Corevalve evolut r, by Medtronic (1 mentions)

9 protocols using artis zeego system

Hybrid Operating Room: A Multidisciplinary Collaboration

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The study context was a hybrid OR, inaugurated in May 2011, located in a university hospital. The room size was 93 m² and the imaging system used was a floor-mounted system called Siemens Artis Zeego system. Figure 1 is an illustration of the hybrid OR in which we conducted our study. The staff that worked in the hybrid OR were specialist physicians, registered nurses (RNs: radiographer, nurse anesthetist and OR nurses) and licensed assistant nurses from both anesthesia and surgery. Collectively, the RNs were called nursing staff throughout this study. The physicians were either vascular surgeons or interventional radiologists, referred to as operators. In Sweden, the registered radiographer has a unique position, as he/she is responsible for the technical planning and execution of the entire radiological examination, as well as providing good nursing care to the patient, including administering medications and intravenous injections. The anesthesia and OR nurses both have academic specialist education; however, the assistant nurses have mainly been trained in practical aspects of the job in different specialist areas.Figure 1

Landscape of the hybrid operating room. Source: Tyréns Arkitekter used (and modified) with permission from Tyréns Arkitekter.

Bazzi M., Lundgren S.M., Hellström M., Fridh I., Ahlberg K, & Bergbom I. (2019). The drama in the hybrid OR: video observations of work processes and staff collaboration during endovascular aortic repair. Journal of Multidisciplinary Healthcare, 12, 453-464.

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Intraoperative 3D Imaging for SPE Placement

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The Artis Zeego system (Siemens Healthcare, Forchheim, Germany), a multi-axis system for interventional imaging with a flat-panel detector, was used for intra-operative 3D imaging. Immediately after insertion, the surgeon used fluoroscopy imaging to rule out the presence of a tip fold-over. Post-operatively, the position of the SPE was evaluated on the CT images by an experienced Head- and Neck Radiologist (BV). For each of the 22 electrode contacts, the location was determined as either an ST or SV position.

Heutink F., Verbist B.M., Mens L.H., Huinck W.J, & Mylanus E.A. (2019). The evaluation of a slim perimodiolar electrode: surgical technique in relation to intracochlear position and cochlear implant outcomes. European Archives of Oto-Rhino-Laryngology, 277(2), 343-350.

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Thoracic Endograft Procedures: Evaluation of Proximal Landing Zones

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In the period from October 2013 to June 2014, a total of 19 thoracic endografts procedures were performed at our institution, but in this study we will pay attention to 13 of them with PLZ 0, 1 and 2. Out of these 13 patients, four patients (30.7%) were involved with insufficient PLZ. Patients were classified into 3 groups according to PLZ (Figure 1.) (6 (link)). Zone 0 included 3 patients(3 male); Zone 1 included 1 patient (1male) and Zone 2 included9 patients (6 males/3 females). The patients characteristics are shown in Table 1.
All patients were operated in our Hybrid Operating Room usinga Siemens Artis Zeego system. For this procedure we used Medtronic Valiant Thoracic prosthesis – Captivia delivery system. For measurement of Stent graft, we used the Trimensio software. We analyzed the duration of surgery, amount of used contras, duration of ICU stay, appearance of the early postoperative complications, neurologic status, and the presence of endoleak. Control analysis was made by computer tomography angiography 3 month safter the procedure.

Kacila M., Vranic H, & Straus S. (2014). Extensive Operation as One of the Solution for Patients with the Insufficient Proximal Landing Zone for TEVAR in Aortic Dissection – short term results. Acta Informatica Medica, 22(6), 356-359.

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Measuring Radiation Exposure in Hybrid OR

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Radiation exposure is reported as air kerma area product (KAP), recorded in milligray [mGy^*cm²]), along with total fluoroscopy time (minutes), both of which are routinely collected in our hybrid operating rooms for each procedure. Kerma is an acronym for “kinetic energy released per unit mass,” and provides an international standard for estimating radiation dose. Notably, our Toshiba Infinix™ VC-i system and the Siemens Artis Zeego^® system have similar methods of KAP determination. This method is guided by FDA standards, with the reference location for determination of KAP at15cm from the isocenter toward the X-ray source along the beam axis.

McNally M.M., Scali S.T., Feezor R.J., Neal D., Huber T.S, & Beck A.W. (2014). Three Dimensional Fusion CT Decreases Radiation Exposure, Procedure Time and Contrast Use during Fenestrated Endovascular Aortic Repair. Journal of vascular surgery, 61(2), 309-316.

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Partial Portal Vein Occlusion Imaging

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Occlusion of the portal vein was obtained using a balloon catheter (XXL Vascular, Boston Scientific), with dimensions adapted to the portal vein diameter, measured with x-ray fluoroscopy. Percutaneous access to an intrahepatic branch of the portal vein was performed under ultrasound (Acuson S3000, Siemens Healthcare) and x-ray fluoroscopy guidance (Artis Zeego system, Siemens Healthcare). The balloon catheter was then introduced in the main trunk of the portal vein under fluoroscopy guidance. The inflation volume in the balloon was calibrated under fluoroscopy for each predetermined degree of portal occlusion (0%, 50%, 80% and 100% of the portal vein diameter). For that purpose, a 1:1 iodine contrast (Visipaque 270, GE Healthcare) in normal saline solution was used for balloon inflation. Representative angiography images for all four animals are provided in Figure 1B, for a balloon catheter dilatation of 80% of the intraluminal portal vein section.

Chatelin S., Pop R., Giraudeau C., Ambarki K., Jin N., Séverac F., Breton E, & Vappou J. (2021). Influence of portal vein occlusion on portal flow and liver elasticity in an animal model. NMR in biomedicine, 34(6).

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Radiation-Minimizing Hybrid Procedure for Valve Deployment

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All procedures were performed in a hybrid operating room, under fluoroscopic and echocardiography imaging guidance, in a standard fashion. All operators wore standard radiation protection equipment, consisting of a leaded vest, skirt, lead glasses, and a thyroid shield. A lead ceiling-mounted shield with a patient contour cutout and a table-mounted lead shield attached to the side of the operating table extending from the table to the floor were present. No RADPAD or Sentinel protection devices were used. The hybrid operating room was equipped with a Siemens Artis zeego system (Siemens, Munich, Germany). ALARA (as low as reasonably achievable) radiation practices were employed for the study. All procedures were conducted using 7.5 frames per second fluoroscopy setting, with minimal cineangiography, using optimal collimation while maintaining a minimal distance between the patient and the image detector, using a maximal source to image distance, and limiting magnification. The C-arm unit was kept in the coplanar angles for valve deployment, and operators utilized posterior-anterior projection and/or slightly right anterior oblique projections for the majority of the procedure to decrease the amount of radiation exposure.

Goel S., Casazza R., Pasam R.T., Montagna E., Gotesman J., Frankel R., Borgen E., Crooke G., Saunders P, & Shani J. (2022). Operator Radiation Exposure During Transfemoral Transcatheter Aortic Valve Replacement. Structural Heart, 6(1), 100002.

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Transcatheter Aortic Valve Implantation

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All patients underwent the procedure by a multidisciplinary team consisting of a cardiac surgeon, interventional cardiologist and anaesthetist in a hybrid operating room (Artis zeego system, Siemens Inc., Forchheim, Germany) under general anaesthesia. The TAVI implantation technique has been described previously [8 (link)]. After successful deployment, angiographic assessment was performed to prove no paravalvular leak and to ascertain good valve function. Extubation was attempted in the operating room to assess the neurological status. All patients underwent standardized postoperative management in our intensive care unit.

Haensig M., Kuntze T., Gonzalez D.L., Lapp H., Lauten P, & Owais T. (2021). Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants. Interactive Cardiovascular and Thoracic Surgery, 34(2), 167-175.

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Robotic Endovascular Rescue for IPAP

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A total of 146 intracranial endovascular procedures were performed in the hybrid OR equipped with the robotic Artis Zeego system (Siemens AG, Forchheim, Germany) between December 2009 and December 2013. All medical charts were reviewed, and five patients with IPAP were identified. All five patients were consented for this report.
IPAP was determined by imaging findings, including immediate cerebral angiography and intraoperative conebeam CT-like images (DynaCT). We were able to start rescue management immediately without moving the patient to another room by performing the following procedures: (1) quick and complete coiling until there was no further extravasation; (2) reversal of anticoagulation with protamine and fresh frozen plasma; (3) aggressive decompression using either immediate EVD insertion for bloody cerebrospinal fluid (CSF) drainage if the patient had not received EVD previously in elective surgical cases, or immediate opening of EVD drainage if EVD had already been inserted before the neuroendovascular procedure in previously ruptured cases. Revision of the EVD was necessary if there was clotting in the EVD drainage system; and (4) delicate post-operative care. Final clinical outcome was evaluated by Glasgow Coma Scale (GCS) and postoperative 3-month modified Rankin Scale (mRS).

Tsuei Y.S., Liao C.H., Lee C.H., Liang Y.J., Chen W.H, & Yang S.F. (2018). Intraprocedural arterial perforation during neuroendovascular therapy: Preliminary result of a dual-trained endovascular neurosurgeon in the neurosurgical hybrid operating room. Journal of the Chinese Medical Association : JCMA, 81(1).

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Transcatheter Aortic Valve Implantation Procedures

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TF-TAVI was preferred as first choice in all patients without severe peripheral artery disease and with suitable femoral axis. Alternatively, the transapical (TA-TAVI) access was used. All procedures were conducted in a hybrid operating room under fluoroscopic control (Artis Zeego System; Siemens AG), general anesthesia, periprocedural TEE, and a cardiac perfusionist with ready-to-use cardiopulmonary bypass on site. All implants were performed by a multidisciplinary team composed of at least a cardiologist (procedure leader in case of TF-TAVI) and a cardiac surgeon (procedure leader in case of TA-TAVI). Four different prostheses are routinely implanted in our center: SapienXT and Sapien3 (Edwards Lifesciences, Irvine, Calif), CoreValve/EvolutR (Medtronic, Minneapolis, Minn), and Acurate TA/NeoTF (Symetis SA, Ecublens, Switzerland). Selection of prosthesis type is agreed preoperatively with the cardiologist and cardiac surgeon on the basis of several parameters, including need for elective PCI after TAVI, annulus dimension, and distance from the aortic annulus to the coronary ostia. Definitive selection of prosthesis size is usually agreed intraoperatively by the Heart Team after evaluation of MDCT (annular perimeter-derived dimensions), TEE, and angiographic parameters (eg, contrast reflux during valvuloplasty and balloon sizing).

Pollari F., Dell'Aquila A.M., Söhn C., Marianowicz J., Wiehofsky P., Schwab J., Pauschinger M., Hitzl W., Fischlein T, & Pfeiffer S. (2019). Risk factors for paravalvular leak after transcatheter aortic valve replacement. The Journal of thoracic and cardiovascular surgery, 157(4).

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