Direct Videoscopic Approach to the Descending Thoracic Aorta for Aortic Arch Endograft Delivery: Evaluation in a Porcine Model

Abstract

Purpose:

To examine the feasibility of a direct videoscopic approach to the descending thoracic aorta for endograft delivery to the aortic arch.

Methods:

A double purse-string suture was placed on the aorta of 3 pigs via a thoracoscopic approach. Subsequently, the aorta was cannulated in the center of the purse-string. A 22-F delivery catheter was advanced under fluoroscopic control over a guidewire via a trocar into the proximal aorta. After deployment of a tubular endograft, the catheter was withdrawn from the aorta while simultaneously tightening the purse-string suture, without aortic cross clamping. The outcome was evaluated by post implant angiography and autopsy results.

Results:

The procedure was successfully completed in all animals, with a mean total procedure time of 126 minutes (range 118–137). Mean endograft implantation time from needle puncture to catheter extraction was 27 minutes (range 21–37). Hemostasis was obtained in all animals after withdrawal of the delivery catheter and tightening the purse-string suture. The mean blood loss was 143 mL (range 80–220). Autopsy proved all purse-string sutures to be adequately placed and all endografts deployed in the correct position.

Conclusion:

A direct videoscopic approach to the descending thoracic aorta proved a feasible technique for endograft delivery to the aortic arch in a porcine model.