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Catheter motion was imposed as boundary condition, and catheter vessel contact was modeled with a Lagrange multiplier formulation to compute vessel deformation. The framework was integrated and tested in vitro using a sensorized catheter with fiber Bragg grating and electromagnetic sensors to provide real-time 3D shape and location as it was advanced by a catheter driver through a silicone replica of the vascular anatomy. Upon registration, real-time sensor read-outs fed the simulation, and the updated catheter and vessel geometries were streamed to Hololens\n                      <jats:inline-formula>\n                        <jats:alternatives>\n                          <jats:tex-math>$$2^{\\textrm{TM}}$$<\/jats:tex-math>\n                          <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                            <mml:msup>\n                              <mml:mn>2<\/mml:mn>\n                              <mml:mtext>TM<\/mml:mtext>\n                            <\/mml:msup>\n                          <\/mml:math>\n                        <\/jats:alternatives>\n                      <\/jats:inline-formula>\n                      (HL2). The performance of the simulation and the accuracy of FEM-computed vessel wall displacement were validated vs. experimental ground truth obtained via stereo frames triangulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Complexity and extent of catheter vessel interaction affected FEM performance by increasing the computational cost. The simulated time exceeded the real temporal extent of the physical phenomenon by 12% during the initial navigation phase and by 45% when the catheter reached the most tortuous portion of the vessel. The HL2 rendering remained stable between 35 and 40 frames per second. Across these two phases, the median\n                      <jats:italic>relative displacement error<\/jats:italic>\n                      between FEM-computed vessel wall displacements and the ground truth remained below 1\u00a0mm and 2.33 mm, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study demonstrates the feasibility of integrating interactive biomechanical simulation with real-time sensor data to enable continuous monitoring of catheter vessel interactions, with mixed reality visualization serving as a user interface to support a more engaged and better-informed operator throughout the navigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11548-026-03731-y","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:58:20Z","timestamp":1781024300000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Catheter monitoring in intelligent endovascular navigation systems: interactive simulations and mixed reality for enhanced navigational awareness"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7445-2165","authenticated-orcid":false,"given":"Veronica","family":"Ruozzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Battista","family":"Regazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Palumbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim-Alexander","family":"Beckers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouloud","family":"Ourak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Perico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Caimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Vander Poorten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiliano","family":"Votta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"issue":"18","key":"3731_CR1","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","volume":"380","author":"MJ Mack","year":"2019","unstructured":"Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P et al (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. 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