{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T13:17:19Z","timestamp":1793020639866,"version":"4.5.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"University of Maryland\u2014Baltimore Life Science Discovery","award":["U01GM152511"],"award-info":[{"award-number":["U01GM152511"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Central venous cannulation is essential for life-saving interventions including resuscitation of critically ill patients, hemodynamic monitoring, endovascular intervention, pressor therapy, dialysis and apheresis, and extracorporeal life support. Cannulation of major arteries is required for cardiac catheterization, endovascular interventions such as arterial stenting or aneurysm repair, as well as emergency interventions such as intra-aortic balloon pumps and extracorporeal membrane oxygenation (ECMO). Both venous and arterial cannulation are commonly performed by specialized providers, and both continue to have significant complications despite the widespread use of ultrasound imaging to aid in cannulation. In the United States, clinicians manually place an estimated 5.0-5.5\u202fmillion central venous catheters (CVCs) and &amp;gt;1\u202fmillion arterial lines annually. Despite guideline\u2011driven adoption of real\u2011time ultrasound, first\u2011pass success remains a challenge, and mechanical complications occur in 5%-19% of attempts. These complications cause additional patient harm and suffering and central line-associated bloodstream infections alone are estimated to exceed $1.3 billion annually. Autonomous or semi\u2011autonomous \u201cautonomous vascular access\u201d (AVA) platforms have the promise to standardize technique, accelerate placement by a wider range of providers, extend cannulation capability to austere settings, and reduce complication\u2011related morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This review summarizes (1) current civilian practice, guidelines, outcomes and epidemiology of vascular access; (2) emergency, combat and trauma\u2011care imperatives that are catalyzing AVA development; (3) fundamental principles and pitfalls that automation must address; (4) experimental models for device evaluation; (5) the present pipeline of robotic and image\u2011guided systems; and (6) essential design criteria for an ideal AVA device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search of PubMed, Scopus, IEEE\u202fXplore, and Google Scholar (January 2015\u202f-December 2025) was conducted using the terms \u201ccentral venous catheter,\u201d \u201carterial cannulation,\u201d \u201crobotic vascular access,\u201d \u201cautomated vascular access,\u201d and related phrases. English\u2011language guidelines from the Society for Vascular Surgery, American Society of Anesthesiologists, European Society for Vascular Surgery, American College of Emergency Physicians, and Joint\u202fTrauma System (JTS) were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Contemporary practice achieves ultrasound\u2011guided first\u2011pass pooled success of 81.5% for all CVC access sites placed by attending physicians but an estimated 60%-75% when performed by trainees. Pneumothorax (0.5%-3%), arterial puncture (1%-3%), malposition (4%-10%), and catheter\u2011associated bloodstream infection remain prevalent. In military Role\u202f1\u20133 environments, rapid arterial or large\u2011bore venous access is prerequisite for REBOA, damage\u2011control resuscitation, and forward ECMO; however, skilled personnel may be scarce, and environmental stressors degrade performance. Benchtop phantoms, perfused swine, and pulsatile cadavers now provide rigorous testbeds for AVA systems. First\u2011generation platforms (AI\u2011GUIDE, CERTA, and Vu-Path) integrate ultrasound vessel segmentation, robotics, haptic force sensing, artificial intelligence (AI) and closed\u2011loop needle control, achieving 90%-100% success in limited series using phantom, porcine, or limited human series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AVA technology remains in early-stage development, with promising but limited evidence from benchtop, animal, cadaveric, and small feasibility studies. No platform has yet demonstrated safety, effectiveness, and operational reliability in adequately powered clinical or military field trials. For adoption, systems must deliver real\u2011time, closed\u2011loop imaging; universal catheter compatibility; portability; robust safety interlocks; cyber\u2011secure data integration; and cost parity with manual cannulation. Multicenter trials powered for clinical and economic endpoints are now imperative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag377","type":"journal-article","created":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T11:34:23Z","timestamp":1785670463000},"source":"Crossref","is-referenced-by-count":1,"title":["Autonomous Vascular Access Devices: Current Solutions and Future Challenges"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8104-9679","authenticated-orcid":false,"given":"Joel","family":"Grunhut","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine , Baltimore, MD 21201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, MD, 20814,","place":["United 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