Artificial Intelligence-Machine Learning and Wearable Technology: Transforming Vascular Health Care

Vascular surgery has evolved from basic repairs and bypasses to endovascular interventions that uses specialized catheters to access and treat diseased vessels from within. The advances in radiological techniques such as intravascular ultrasound (IVUS) and angiography have enhanced the precision and safety of complex vascular procedures. Despite these advances, growing global population and constant need to deliver evidence based, safe and effective care heralds the need to incorporate Internet of Medical Things (IoMT) in our surgical practice. The IoMT, also known as the Internet of Things in healthcare, refers to connecting people in different roles with various medical devices and objects in the medical scene to establish a common platform where people-to-people, people-to-things, and things-to-things are all freely connected and share information.1 In the last decade, the wearable technology and near field communication devices have emerged as a hot technology field in health care. The global wearable medical device market is projected to grow from USD 103.04 billion in 2025 to USD 324.73 billion by the year 2032.2 In India, the highest percentage of ownership is observed, with 57% of respondents owning wearable devices.3 This observed increased ownership especially in post-COVID-19 era suggest that healthcare industry and common man is embracing digital backbone. SALIENT FEATURES OF WEARABLE TECHNOLOGY Wearable devices include smartwatches, bands, patches, rings, medical ear buds, and clothing-embedded devices. The motion and biometric sensors embedded in these devices capture physiologic parameters such as heart rate (HR), rhythm, blood pressure (BP), oxygen saturation, and temperature. The commonly used sensors in wearable technology are as follows: Accelerometer It is microelectromechanical system (MEMS) sensor that measures acceleration of an object using capacitive, piezoresistive, and peizoeclectris effects.4 Example: Precision medicine uses accelerometers/activity trackers to collect the data about a patient’s daily physical activities, which is critical for tailoring treatment plans especially for home-based exercise program and postoperative vascular rehabilitation MEMS accelerometers are used to calibrate the magnetic resonance imaging and computed tomography (CT) scanners to ensure accurate alignment and positioning during imaging, preventing errors in diagnostics. Surgical tools can use motion sensors to track the correct positioning of surgical instruments, improving precision during minimally invasive surgeries. Photoplethysmogram The photoplethysmogram (PPG) signal is an optical measure of arterial blood volume. In wearable devices, it is typically measured by shining a light on to the skin and measuring the amount of light reflected back from the skin. The resulting signal is dominated by a pulse wave due to the change in blood volume with each heartbeat.5 Example: Pulseoximeter tracks HR and SpO2 Arterial photophlethysmography (APPG) is used to assess arterial stiffness. Electrocardiogram Wearable electrocardiogram (ECG) devices could be in the form of an “on-body patch” or a contact-less sensor as a smart watch, “textile-base” vest, or capacitive sensors integrated within patients’ stretchers, beds, and wheelchairs.6 These sensors capture electrical potential between various points on the body and depict depolarization and repolarization of the heart. Seismocardiogram and ballistocardiogram Seismocardiogram (SCG) measures mechanical activity of the heart (valve opening/closing). Ballistocardiogram (BCG) measures recoil force of the body in response to ejection of blood from the heart. These devices can be in the form of on body patch or wrist bands. Example: Wearable watch based SCG, BCG and PPG devices track BP, Cardiac output and contractility, thereby help in screening for and management of preeclampsia.7 ROLE OF ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING IN WEARABLE DEVICES The wearable devices have huge volume of information which requires intelligent algorithms and computational power to generate meaningful information. The artificial intelligence (AI) and machine learning (ML) technologies utilized for wearable technology can be classical ML techniques such as multilayer perceptron, support vector machines, decision trees, linear discriminant analysis, random forest algorithms, Bayesian approaches, and hidden Markov models or deep learning techniques such as convolutional neural networks, recurrent neural networks, long short-term memory networks, deep reinforcement learning, and stacked autoencoder architectures.8 Deep learning techniques in wearable devices are used to utilize feature engineering of human behavior, activity recognition, pattern recognition, and to attain precision. ML with IoT use skin temperature, pulse rate, and motion sensors enable personalized and proactive healthcare interventions. Miniaturization of sensors, improved battery life, and wireless connectivity are promoting increased telehealth and remote patient monitoring (RPM) programmes, thereby, resulting in better patient outcomes, increased quality-adjusted life years, better resource allocations and minimal hospital visits and cost-effective health care.9 ROLE OF WEARABLE TECHNOLOGY IN PREOPERATIVE PLANNING OF VASCULAR PATIENTS In patients with intermittent claudication monitoring patient’s response to home-based supervised claudication exercises or Cilosatazole will help in informed decisions regarding surgical interventions. Use of motion sensors to assess preop fitness in terms fatigue levels and mobility can help in holistic assessment of patient fitness before major abdominal surgery like open aneurysm repair and at the same time identify patients with worst recovery trajectories who merit early intervention and robust postoperative rehabilitation.10 CT or MR images are reconstructed and holographic displays are being explored for use in augmented reality (AR) headsets and smart glasses, to offer immersive and potentially more natural interaction with digital content. This assists the surgeon preoperatively to select the optimal path in complex open surgical that results in safer and faster dissection of tissues in open surgical repair, avoiding any potential iatrogenic injury and eventually better patient outcome.11 Wearable AR devices provide three-dimensional (3D) vascular anatomy that aids in visualizing the location, size, and extent of stenosis/aneurysm and thereby choosing the appropriate hardware to treat the lesion by endovascular means. ROLE OF WEARABLE TECHNOLOGY INTRAOPERATIVELY FOR VASCULAR AND ENDOVASCULAR PROCEDURES In open vascular surgery procedures, AR can overlay preoperative 3D images onto surgical field, allowing the surgeon to locate the target distal anastomotic site and plan a limited incision based on the anatomic reference point.12 Use of AR, especially in complex open vascular procedures helps in dissecting in the right planes and avoid iatrogenic injuries. During endovascular procedures, using image overlay techniques and using magnetic trackers at tip of catheters to orientate the catheter in real time improves the operator’s understanding of the 3D anatomy during critical steps, reduces operative time, contrast exposure, and radiation exposure.13 Use of precision guidance systems such as inertial measurement units (IMUs) can track the position and orientation of surgical instruments, providing real-time feedback to the surgeon. This can be particularly valuable in endovascular procedures, where accurate catheter and guidewire placement is essential. By combining IMU data with preoperative imaging data, surgeons can navigate through the vascular system with greater precision, minimizing the risk of vessel perforation or other complications. In addition, wearable haptic devices can provide tactile feedback to the surgeon, enhancing their sense of touch and improving their ability to manipulate instruments within the vascular system. Wearable sensors can provide real-time monitoring of patients’ physiological parameters during vascular surgery, allowing for immediate detection and management of complications. ECG sensors can detect arrhythmias or ischemic changes, while BP sensors can identify hypotension or hypertension. Oxygen saturation sensors can monitor for hypoxemia, and temperature sensors can detect hypothermia or hyperthermia. This real-time feedback allows anesthesiologists and surgeons to respond quickly to changes in the patient’s condition, optimizing hemodynamic stability and minimizing the risk of adverse events. Furthermore, wearable sensors can be integrated with alarms and alerts, providing timely notification of critical events. ROLE OF WEARABLE TECHNOLOGY IN POSTOPERATIVE MONITORING AND CARE Continuous vital sign tracking Postoperative period is critical for patient outcome and to prevent complications. Wearable devices facilitate continuous, remote monitoring of vital signs, including HR, BP, respiratory rate, and oxygen saturation and aid in the early identification of potential problems such as infection, bleeding, or graft occlusion, enabling timely intervention, and potentially preventing serious adverse outcomes. Use of sensors to assess limb temperature, SpO2, TcPO2 or PPG can help in the timely detection of occlusion of blood flow. Noninvasive laser Doppler flowmeter sensor can measure real-time microvascular circulation and help in detecting ischemia or thrombosis.14 Remote patient monitoring RPM using wearable devices offers a convenient and cost-effective way to manage patients after vascular surgery. RPM enables healthcare providers to track patient progress from a distance, reducing the need for frequent in-office visits and hospital readmissions. RPM systems can be integrated with telehealth platforms, allowing for virtual consultations and remote adjustments to medication or therapy regimens. For example, Robaldo et al. used RPM system to monitor patients after carotid endarterectomy and treated 31% patients with hypertensive events by administering amlodipine.15 monitoring postoperative physical activity levels can help identify patients at risk of deep-vein thrombosis and aid to start timely anticoagulation treatment. ROLE OF WEARABLE TECHNOLOGY IN VASCULAR REHABILITATION Personalized exercise programs Accelerometers, gyroscopes, and GPS trackers can assist healthcare providers to adjust the intensity and frequency of recovery programs. Virtual telerehabilitation plays a crucial role in delivering personalized home-based supervised exercise program tailored to individual patient needs and abilities especially for lower extremity artery disease.16 Patient engagement and adherence One of the significant advantages wearables offer is their ability to engage and empower patients in self-managing their health. Activity trackers can display daily step counts, distance travelled, and calories burned, motivating patients to stay active and achieve their exercise goals. Gamification elements, such as badges, rewards, and leaderboards, can further enhance motivation and engagement. Real-time feedback, social support networking, and online expert consultation can significantly improve the effectiveness of vascular rehabilitation programs.17 WEARABLE TECHNOLOGY AND WOUND CARE In chronic diabetic and delayed healing wounds, wearable devices can provide continuous monitoring of wound parameters, such as temperature, pH, oxygen levels, moisture levels, and biochemical markers enabling the early detection of complications and personalized treatment adjustments.18,19 For example, engineered smart bandage incorporates sensors for pH and temperature that can detect inflammation in the wound. The thermoresponsive drug carrier within hydrogel patch deliver antibiotic to the wound once it receives signals from integrated electronic wireless transmitter.20 This integration facilitates continuous and remote monitoring, allowing healthcare professionals to gather valuable insights into the dynamic progression of chronic skin conditions. WEARABLE TECHNOLOGY AND ENHANCED SURGICAL TRAINING Wearable technology can enhance surgical training through simulation and real-time feedback and help surgeons maintain proper ergonomic posture and reduce physical strain during long procedures. Lareyre et al. demonstrated that the use of head-mounted display (HMDs), VR enabled smart glasses provided young surgeons with valuable immersive 3D learning experiences.21 DATA PRIVACY AND REGULATORY CHALLENGES The wearable devices collect patient sensitive data that has to be protected from potential misuse. Healthcare providers and wearable device manufacturers must comply with HIPAA, GDPR or the European Union Medical device regulation.22–24 Instead of centralizing data from multiple sources to train an algorithm, federated learning in Ai uses decentralized approach to train algorithms, and thus, data are safety and privacy is assured.25 However, data ownership is an ongoing issue, which may result in unauthorized sharing of user data without explicit and prior approval. WEARABLE TECHNOLOGY AND COST-EFFECTIVENESS The initial investment in wearable devices and monitoring systems can be substantial, however, the telemedicine services significantly reduces travel time, cost and assists in earlier detection of complications. Paquette and Lin26 observed that telemedicine services saved an average of 31.2 miles in driving distance, 39 min of travel time and had environmental benefit through the reduction of greenhouse gas and pollutant emissions. Home-based supervised exercise therapy that used triaxial accelerometer wearable monitors costed as little as 20 euros and was cost-effective as compared to hospital-based exercise therapy.27 CONCLUSION Wearable devices have transformative potential in vascular surgery, offering opportunities to enhance preoperative planning, improve intraoperative precision, and enable more effective postoperative management and rehabilitation. Continuous monitoring, personalized treatment plans, and RPM can lead to improved patient outcomes, reduced healthcare costs, and increased efficiency. While challenges remain in data privacy, system integration, and regulatory approval, the benefits of wearable technology in this field are undeniable. As sensor technology advances and AI/ML algorithms become more sophisticated, wearable devices will play an increasingly important role in vascular surgery. Collaboration between healthcare providers, technology developers, and regulatory agencies is essential to accelerate the development and adoption of wearable technology in vascular surgery.