Augmented and virtual reality for preprocedural planning and intraprocedural guidance in transplant hepatic artery stenting

PURPOSE: Hepatic artery stenosis is a recognized vascular complication after orthotopic liver transplantation, and endovascular treatment is technically demanding because of variable post-surgical anatomy. Augmented and virtual reality (AR/VR) allows immersive review of patient-specific three-dimensional imaging, but its clinical application to transplant hepatic artery interventions remains poorly described. This study evaluated the feasibility, usability, and perceived impact of AR/VR for preprocedural planning and intraprocedural guidance in transplant hepatic artery (HA) stenting. METHODS: This IRB-approved single-center pilot study included eight consecutive patients undergoing transplant HA stenting from January 2025 to May 2026. Preprocedural planning was performed using an AR/VR headset and spatial computing software. In the final three cases, AR was used intraprocedurally to display live fluoroscopy during the procedure. Postprocedure surveys assessed workflow integration, anatomic visualization, confidence, usability, and comfort using 5-point Likert scales. RESULTS: Cases were emergent in 12.5% and elective in 87.5%; 62.5% were high complexity. All cases were technically successful without major complications. Median case, fluoroscopy, and AR/VR planning times were 159.5, 34.8, and 4.5 min, respectively; median air kerma was 678 mGy. AR/VR planning represented 3.6% of case time and was perceived to change the approach in 6/8 cases (75%). Visualization, workflow integration, confidence, and anatomic understanding each received median scores of 5. Headset comfort was lowest-rated. Intraprocedural AR was successful in all 3 cases. CONCLUSION: AR/VR planning for transplant HA stenting is feasible, influencing procedural strategy in 75% of cases with maximum operator ratings for visualization, confidence, and workflow integration. Intraprocedural AR during transradial access was feasible.