An angioscopic method for intraluminal aortic evaluation and stent placement

Aortoscopy: a guidance system for endoluminal aortic surgery

PURPOSE

The aim of this project was to evaluate the feasibility of aortoscopy for guidance of endoluminal aortic procedures and to determine whether aortoscopy has advantages over fluoroscopy in a pig model.

METHODS

To establish feasibility aortoscopic guidance was used for making endoluminal aortic measurements, cannulating small arteries for arteriograpy, and placing intraaortic stents and grafts in 11 pigs. To compare aortoscopy and fluoroscopy measurements were made and stents were placed by a surgeon using only aortoscopic guidance in 10 pigs and by an interventional radiologist using only fluoroscopic guidance in 10 pigs. Postmortem dissections were performed to determine measurement and device placement accuracy.

RESULTS

In the feasibility study aortoscopic measurements differed from postmortem measurements by a mean distance (+/- SD) of 1.2 +/- 0.2 mm. Stents and grafts were placed a mean of 2.3 +/- 1.9 mm distal to the most inferior renal artery with no stent covering an orifice. All attempts at cannulating spinal arteries greater than 2 mm in diameter were successful. In the comparison of aortoscopic and fluoroscopic guidance, fluoroscopic measurements differed from postmortem measurements by 2.6 +/- 2.4 mm (p = 0.223). Stents placed with aortoscopic guidance were 1.1 +/- 1.3 mm distal to the most inferior renal artery, whereas stents placed with fluoroscopic guidance were 3.4 +/- 2.5 mm distal to the most inferior renal artery (p = 0.019).

CONCLUSIONS

These results demonstrate that aortoscopy is a useful guidance system for endoluminal aortic procedures and may have advantages over fluoroscopy alone.

Angioscopic evaluation of an endoluminal aortic graft: the first clinical experience

PURPOSE

Balloon aortoscopy has been described for viewing aortic endoluminal anatomy and guiding aortic stent placement in animals. We report the first clinical use of this technique to visually inspect the proximal portion of a 1-year-old endovascular aortic graft, its proximal fixation stent, and its relationship to the renal arteries.

METHODS

The aortoscope is a modified fiber-optic endoscope that is fitted over the lens with a transparent, saline-filled balloon for blood displacement. Its performance was evaluated in a 62-year-old woman who had a Parodi-type Dacron/modified Palmaz stent endoluminal graft implanted to exclude an infrarenal aortic aneurysm in 1994. One year later, during an angioplasty procedure for symptomatic left subclavian and left common iliac artery stenoses, the 1-year-old endoluminal graft was inspected with the balloon-tipped angioscopic assembly.

RESULTS

Introduced via the left brachial artery, the aortoscope provided a panoramic view of the endoluminal surface through the solution-filled balloon. The endoluminal aortic graft was clearly identified, as were both renal artery orifices proximal to the graft. The surface of the proximal stent was smooth and without exposed metal. No complications occurred with the angioscopy technique.

CONCLUSIONS

Aortic angioscopy can be used to evaluate endoluminal aortic grafts and endoluminal anatomy. It provides clear, magnified views that may be useful for guiding precise placement and assessing the function and healing of endoluminal devices in the aorta.