Feasibility of fresh frozen human cadavers as a research and training model for endovascular image guided interventions

Abstract

Objective To describe the feasibility of a fresh frozen human cadaver model for research and training of endovascular image guided procedures in the aorta and lower extremity. Methods The cadaver model was constructed in fresh frozen human cadaver torsos and lower extremities. Endovascular access was acquired by inserting a sheath in the femoral artery. The arterial segment of the specimen was restricted by ligation of collateral arteries and, in the torsos, clamping of the contralateral femoral artery and balloon occlusion of the supratruncal aorta. Tap water was administered through the sheath to create sufficient intraluminal pressure to manipulate devices and acquire digital subtraction angiography (DSA). Endovascular cannulation tasks of the visceral arteries (torso) or the peripheral arteries (lower extremities) were performed to assess the vascular patency of the model. Feasibility of this model is based on our institute’s experiences throughout the use of six fresh frozen human cadaver torsos and 22 lower extremities. Results Endovascular simulation in the aortic and peripheral vasculature was achieved using this human cadaver model. Acquisition of DSA images was feasible in both the torsos and the lower extremities. Approximately 84 of the 90 target vessels (93.3%) were patent, the remaining six vessels showed signs of calcified steno-occlusive disease. Conclusions Fresh frozen human cadavers provide a feasible simulation model for aortic and peripheral endovascular interventions, and can potentially reduce the need for animal experimentation. This model is suitable for the evaluation of new endovascular devices and techniques or to master endovascular skills.

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

“…In vivo human cadaveric perfusion models with extracorporeal circulation have been suggested previously for central perfusion of the thoracic and abdominal aorta. These models were mainly used for performance testing of new technical devises or surgical methods [ 6 , 7 , 12 , 14 , 15 ] and teaching/training of medical staff [ 5 – 8 , 10 – 12 , 16 ] but considerably less often for research purposes [ 12 , 16 , 17 ]. Recently, a peripheral cadaveric model was investigated using dissected lower extremities filled up with contrast fluid, however, the lack of a simulated circulation imposed considerable restrictions [ 12 ].…”

“…These models were mainly used for performance testing of new technical devises or surgical methods [ 6 , 7 , 12 , 14 , 15 ] and teaching/training of medical staff [ 5 – 8 , 10 – 12 , 16 ] but considerably less often for research purposes [ 12 , 16 , 17 ]. Recently, a peripheral cadaveric model was investigated using dissected lower extremities filled up with contrast fluid, however, the lack of a simulated circulation imposed considerable restrictions [ 12 ]. While still underrepresented in the medical literature, cadaver models of the peripheral vascular system are of great interest when conducting comparative studies using ionizing radiation as well as for training of interventional procedures in protected conditions.…”

“…Further advantages include lifelike conditions in genuine interventional labs, representative anatomy, and pathophysiology as well as realistic tactile feedback. In contrast to the previously mentioned model using dissected lower extremities, our model offers the option to perform realistic DSA because of the continuous flow [ 12 ]. Therefore, our model can be used to simulate an entire angiographic procedure including the arterial puncture, introduction of a working sheath in Seldinger technique, diagnostic imaging, advancing guide wires and catheters, applying intravascular procedures, and completing the procedure with retraction of all devices and closure of the vascular access.…”

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“…Most fresh frozen donors can only be used for an average of four freeze-thaw cycles due to soft tissue deterioration following extensive or prolonged use, limiting the potential for further educational dissection following surgical skills sessions (Jansen et al, 2020). At Queen's University, we find that the regions of the body that are most in demand for surgical skills or medical research (anterior neck, knees, thorax, etc.)…”

Humán kadávermodell a légmell ágy melletti ultrahang-diagnosztikájához.

“…A feszülő légmell kialakulási dinamikája a klinikai gyakorlatban szinte lehetetlenné teszi az ágy melletti komplex készségátadást az ultrahangos diagnosztika tekintetében. Az erre irányuló képzés így alapvetően korábban rögzített képanyag megtekintésében merül ki [4,17,18]. Potenciálisan szóba jönnek kifejezetten erre a célra gyártott fantomok is, ezek ára azonban gátat szabhat alkalmazásuknak.…”