Wearable headset-assisted fluoroscopic visualization during complex endovascular aortic repair

Complex endovascular aortic repair (EVAR) frequently requires simultaneous femoral and upper-extremity access, particularly during multibranched endograft implantation, branched thoracic EVAR, and other procedures requiring target-vessel catheterization from the arm. In hybrid operating rooms, the arm-side operator often has a limited or obstructed view of the primary fluoroscopy monitor because of the image intensifier, patient position, equipment, radiation shielding, or distance from the main display. Although secondary monitors can be used, they may be small, poorly positioned, or difficult to align with the operator's working angle. We describe a simple wearable headset-assisted fluoroscopic visualization technique using commercially available components, including XREAL One Pro glasses (XREAL, Inc), a wireless high-definition multimedia interface transmission module, and a digital visual interface-to-high-definition multimedia interface connector. The system allows the live fluoroscopic image to be displayed as an individualized virtual monitor within the operator's field of view while preserving awareness of the operative field through a see-through display and adjustable shading. The headset can provide a stable three-degree-of-freedom or six-degree-of-freedom image as needed. This technique may be particularly useful for the arm-side operator during multibranch endograft procedures or branched thoracic EVAR, where precise wire, catheter, sheath, and bridging stent manipulation is required. Wearable headset-assisted fluoroscopic visualization may simplify hybrid operating room setup, reduce dependence on monitor positioning, and improve operator ergonomics. Further evaluation is needed to assess its effect on procedure efficiency, fluoroscopy time, radiation exposure, operator workload, and safety.