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Endovascular creation of aortic dissection in a swine model with technical considerations  Teruaki Okuno, MD, Masato Yamaguchi, MD, Takuya Okada, MD,

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Presentation on theme: "Endovascular creation of aortic dissection in a swine model with technical considerations  Teruaki Okuno, MD, Masato Yamaguchi, MD, Takuya Okada, MD,"— Presentation transcript:

1 Endovascular creation of aortic dissection in a swine model with technical considerations 
Teruaki Okuno, MD, Masato Yamaguchi, MD, Takuya Okada, MD, Takuya Takahashi, MD, Noriaki Sakamoto, MD, Eisuke Ueshima, MD, Kazuro Sugimura, MD, Koji Sugimoto, MD  Journal of Vascular Surgery  Volume 55, Issue 5, Pages (May 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 A, From top to bottom: 14 G stiffening metallic cannula, modified 10F outer catheter, and 10F introducer sheath of the Rösch-Uchida Transjugular Liver Access Set. B, From top to bottom: Brockenbrough needle, dilator, and 8F introducer sheath. C, Stiffening cannula provides optimal angulation to create the initial dissection. D, Modified 10F outer catheter that is cut with a scalpel to conform to the aortic wall. E, Brockenbrough needle to create the reentry at proximal site. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 A, An intraoperative fluoroscopic image demonstrates the tip of the outer catheter forced leaning on the left lateral wall of the abdominal aorta. B and C, A schema representing creation of the initial dissection. The tip of the outer catheter is forced into the vessel wall to create the initial dissection. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 A, An intraoperative fluoroscopic image demonstrates the creation of a dissected space using a 100-cm 4F straight catheter and the loop formation of a .035-inch guidewire. B, A schema of the steps used during this procedure. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 A, A fenestration from the false lumen to the true lumen is created using a Brockenbrough needle. Note the occlusion balloon catheter (black arrow) in the true lumen of the aorta as a landmark for the point of reentry. The arrowhead indicates the Brockenbrough needle and the double arrows indicate the .010-inch guidewire that is inserted into the true lumen. B, Balloon dilatation of the fenestration with an 8-mm microballoon catheter (white arrow). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 Fig 5 A, Aortography reveals the dissection flap (arrow) and extension of the dissection in the thoracoabdominal aorta. B, Cone beam computed tomography (CBCT) demonstrates the aortic dissection with a smooth patent false lumen. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Longitudinal patefaction of a part of the descending thoracic aorta taken from a swine that was sacrificed immediately after the first procedure. The created dissection is slightly spiral. Arrowhead shows proximal fenestration. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

8 Fig 7 A, On macroscopic examination, the created dissection is located in the media layer of the aorta; this feature is identical to that observed in conventional aortic dissections occurring in humans. B, On microscopic examination, the dissected layer is located within the media layer (hematoxylin and eosin stain, ×4 magnification). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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