Direct intra-aneurysm sac pressure measurement using tip-pressure sensors: In vivo and in vitro evaluation Nuno V. Dias, MD, Krassi Ivancev, MD, PhD,

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Direct intra-aneurysm sac pressure measurement using tip-pressure sensors: In vivo and in vitro evaluation Nuno V. Dias, MD, Krassi Ivancev, MD, PhD, Martin Malina, MD, PhD, Jan-Willem Hinnen, MD, Michel Visser, MD, Bengt Lindblad, MD, PhD, Björn Sonesson, MD, PhD Journal of Vascular Surgery Volume 40, Issue 4, Pages 711-716 (October 2004) DOI: 10.1016/j.jvs.2004.07.045 Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, Schema of aneurysm model driven by an artificial left-heart. Artificial heart consisted of a 70-mL chamber (A), and was driven by a pneumatic driver (B). Compliance of the model was adjusted with an air chamber (C). Aneurysms made of thoracic pig aorta could be attached to a side port (D). One working side port (E) enabled introduction of catheters. A blood pressure cuff around a segment of rubber tubing was available to adjust peripheral resistance (F). System included 3 valves (G, H), an open reservoir (I), and a flow transducer (J). Starch solution was used as perfusate. B, Amplification of part of aneurysm model during experiments. Pressure was measured simultaneously in the lumen of the model and within the aneurysm thrombus with tip-pressure sensors mounted on 0.014-inch guide wires. A 4F angiographic catheter (K) was introduced through the working side port. This catheter was used for insertion of a long-tipped guide wire (L), placing the sensor in the lumen of the side port to which the aneurysm (D) was connected. Pressure within the thrombus of the saccular aneurysm was measured with a short-tipped guide wire (M) inserted through a 20-gauge needle (N). Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 2 Translumbar puncture of the abdominal aortic aneurysm sac for direct intraaneurysm sac pressure measurement in vivo under fluoroscopic guidance. A, Down-the-barrel technique was used, with the stent graft and surrounding bony structures as landmarks. B, Perpendicular projection was used to evaluate depth of the puncture. Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 3 Example of recording of direct intraaneurysm sac pressure measurement. Intraaneurysm (green curve) and systemic pressures (red curve) were recorded simultaneously. After each recording the system used 10 consecutive heart cycles to calculate mean values of systolic/diastolic (mean) pressures (on right side of image). Mean pressure index (MPI) is calculated as percentage of intraaneurysm sac pressure relative to systemic pressure. Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 4 Effects of straining on retroperitoneal pressure. Red curve, Systemic recording; green curve, translumbar recording. Horizontal (“nonpulsatile”) lines, Mean pressure. Retroperitoneal pressure increases during short peaks of intraabdominal pressure (arrows). Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 5 Direct intraaneurysm sac pressure measurement recording during withdrawal of sensor into retroperitoneum. Red curve, Systemic pressure register; green curve, intraaneurysm sac pressure register. Pressure reduction (arrow) occurred on withdrawal of sensor from aneurysm sac (59/43 mm Hg; mean, 49 mm Hg) into retroperitoneum (6 mm Hg). Horizontal (“nonpulsatile”) lines, Mean pressures. Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 6 Variability between in vitro mean pressures in lumen of aneurysm model and within aneurysm thrombus (Bland-Altman plot). Delta mean pressure (y-axis) represents difference between mean luminal and intraaneurysm pressures. Horizontal lines, Median (1 mm Hg) and 5th and 95th percentiles (−5-15 mm Hg). Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 7 In vivo intraobserver variability of direct intraaneurysm sac pressure measurement with 2 repeated punctures in 15 patients (Bland-Altman plot). Delta mean pressure index (MPI) is difference between MPIs measured in first and second punctures. Horizontal lines, Median (0%) and 5th and 95thpercentiles (−7%-17%). Journal of Vascular Surgery 2004 40, 711-716DOI: (10.1016/j.jvs.2004.07.045) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions