Robotics and Image-Guided Navigation in Complex Endovascular Procedures: A Systematic Review of Current Trends

Abstract

Robotics and image-guided navigation are reshaping the landscape of complex endovascular procedures by offering higher precision, reduced radiation exposure, and improved clinical control in anatomically challenging vascular environments. This systematic review analyzes current advancements in robotic catheterization systems, hybrid navigation platforms, and real-time imaging modalities such as fluoroscopy, 3D rotational angiography, intravascular ultrasound, optical coherence tomography, and augmented reality overlays. Recent evidence shows that robotic systems enhance the stability of endovascular tools, minimize operator fatigue, and allow finer manipulation during interventions involving tortuous vessels, aortic arches, neurovascular territories, and peripheral arterial pathways. Image-guided frameworks, meanwhile, enable continuous anatomical mapping, fusion imaging, and predictive path-planning models that significantly reduce intraoperative uncertainty. Across the studies reviewed, combined robotic-navigation ecosystems demonstrate consistent reductions in procedural errors, improved catheter reachability, and enhanced visualization in high-risk procedures including aneurysm coiling, thoracic endovascular aortic repair, and complex coronary interventions. However, challenges involving system cost, workflow integration, haptic feedback limitations, and training requirements still limit universal adoption.