Total endovascular aortic arch reconstruction via fenestration in situ with cerebral circulatory support: an acute experimental study☆☆☆

Abstract

The online version of this article, along with updated information and services, is AbstractThe aim of this experimental study is to evaluate the feasibility of endovascular repair of the complete aortic arch by using novel fenestration devices with simultaneous support of the cerebral circulation. Two fresh human cadavers and five Yorkshire pigs were used for the experiments. In human cadavers the thoracic aorta was pressurized using a roller pump to simulate the circulation. In animal experiments right femoral artery to right distal carotid artery bypass circuit was achieved in order to support the cerebral circulation during the stent graft deployment, fenestration and conduit fixation procedures. Commercially available Valiant Thoracic Stent Grafts, covered stents, steerable guiding catheters and dilatation balloons were used. Stent grafts were deployed successfully and two fenestrations and one conduit implantation were achieved in each cadaver. All animals survived the stent graft implantation, fenestration and conduit implantation procedures. Cadaver dissection and necropsy of the animals revealed good fixation of the conduits into the fenestrated segments of the stent graft. Endovascular repair of the total aortic arch via in situ fenestration of the stent graft using cerebral circulatory support seems to be feasible and safe. Further studies are required before clinical adoption of this procedure.

Lifelike Vascular Reperfusion of a Thiel-Embalmed Pig Model and Evaluation as a Surgical Training Tool

“…Moreover, storage time of fresh tissues is short. Similarly, the majority of researchers have filled the vessels of embalmed human heads or whole bodies with aqueous solutions [9,10,11,12,14,16,17,19,20,21,23,33,34]. Unlike water, hydrophobic perfusates (e.g., PP) are more confined to vessels, and the capacity to extravasate depends on their viscosity [18,29,35].…”

“Squid-Capture” Modified In Situ Stent–Graft Fenestration Technique for Aortic Arch Aneurysm Repair

“…There are several reports regarding the in situ fenestration of stent-grafts for the treatment of TAAs, wherein the initial holes were created using a needle or a laser catheter in a retrograde fashion from the target vessel, dilated by balloons and then reinforced by covered or uncovered stents to maintain perfusion [3][4][5][6]. Throughout our clinical experiences with in situ fenestration, we often encounter difficulty in delivering the needle to the proper position due to poor control of the delivery sheath of the needle.…”

“…In this technique, the stent-graft is first deployed in the aorta prior to being punctured and then fenestrated in situ by a retrograde approach from the target vessel. This technique also can be adapted to revascularize the brachiocephalic artery after a zone 0 landing, which allows endovascular aortic arch reconstruction without performing a sternotomy or aortic side clamping [3][4][5]. We were fortunate to puncture the graft successfully at a proper position via the brachiocephalic artery in our first reported case [3]; however, there was a limitation of the in situ fenestration technique due to the anatomy.…”

Endovascular techniques for arch vessel reconstruction

“…If the orifices of the carotid arteries require coverage, cerebral perfusion will need to be maintained with a temporary arterial shunt. 2,3 Access for the thoracic aortic stent is typically obtained via the common femoral or external iliac arteries. Each of the arch vessels requiring revascularization at the time of thoracic grafting is exposed and controlled through standard exposure techniques.…”