Continuous extracorporeal femoral perfusion model for intravascular ultrasound, computed tomography and digital subtraction angiography

Abstract

Objectives We developed a novel human cadaveric perfusion model with continuous extracorporeal femoral perfusion suitable for performing intra-individual comparison studies, training of interventional procedures and preclinical testing of endovascular devices. Objective of this study was to introduce the techniques and evaluate the feasibility for realistic computed tomography angiography (CTA), digital subtraction angiography (DSA) including vascular interventions, and intravascular ultrasound (IVUS). Methods The establishment of the extracorporeal perfusion was attempted using one formalin-fixed and five fresh-frozen human cadavers. In all specimens, the common femoral and popliteal arteries were prepared, introducer sheaths inserted, and perfusion established by a peristaltic pump. Subsequently, we performed CTA and bilateral DSA in five cadavers and IVUS on both legs of four donors. Examination time without unintentional interruption was measured both with and without non-contrast planning CT. Percutaneous transluminal angioplasty and stenting was performed by two interventional radiologists on nine extremities (five donors) using a broad spectrum of different intravascular devices. Results The perfusion of the upper leg arteries was successfully established in all fresh-frozen but not in the formalin-fixed cadaver. The experimental setup generated a stable circulation in each procedure (ten upper legs) for a period of more than six hours. Images acquired with CT, DSA and IVUS offered a realistic impression and enabled the sufficient visualization of all examined vessel segments. Arterial cannulating, percutaneous transluminal angioplasty as well as stent deployment were feasible in a way that is comparable to a vascular intervention in vivo. The perfusion model allowed for introduction and testing of previously not used devices. Conclusions The continuous femoral perfusion model can be established with moderate effort, works stable, and is utilizable for medical imaging of the peripheral arterial system using CTA, DSA and IVUS. Therefore, it appears suitable for research studies, developing skills in interventional procedures and testing of new or unfamiliar vascular devices.

Comparison of ultrahigh and standard resolution photon-counting CT angiography of the femoral arteries in a continuously perfused in vitro model

“…A recent investigation was able to demonstrate the dose reduction and image quality optimization potential of PCD-CT in SR mode compared to energy-integrating detector CT using similar scanner settings [ 28 ]. Of note, the authors stated that the SR scan mode was deliberately used instead to achieve maximal comparability.…”

“…Perfusion was established via vascular accesses in the groin and below the knee by means of a pump circuit and examined under flux to simulate a standard pelvic-leg CTA. Details of the experimental setup and the preparation of the cadaveric specimens can be found elsewhere [ 28 ].…”

Training for endovascular therapy of acute arterial disease and procedure-related complication: An extracorporeally-perfused human cadaver model study

“…A schematic of the experimental setup is shown in Fig 1 . Detailed explanations of the preparatory work and the materials required can be found elsewhere [ 13 ].…”

“…Some larger centers even offer virtual angiography training suites, which facilitate the simulation of various interventions, albeit with a limited degree of realism and practical applicability due to the absence of human tissue properties and blood flow [ 12 ]. Both of these aspects have recently been addressed in a human cadaveric model with continuous extracorporeal perfusion [ 13 ]. While this model has previously been used for image quality comparisons between CT angiography scan protocol, its application for endovascular interventional training procedures has not been investigated yet.…”

Standardized assessment of vascular reconstruction kernels in photon-counting CT angiographies of the leg using a continuous extracorporeal perfusion model

“…1 . Detailed background information on the establishment of the extracorporeal perfusion model and the necessary materials can be found elsewhere 25 .

Figure 1 Perfusion circuit schematics.

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