Direct videoscopic approach to the descending thoracic aorta for aortic arch endograft delivery: evaluation in a porcine model.
OBJECTIVE
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 After deployment of a tubular endograft, the catheter was withdrawn from the aorta while simultaneously tightening the purse-string suture, without aortic cross clamping.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.


CONCLUSIONS
A direct videoscopic approach to the descending thoracic aorta proved a feasible technique for endograft delivery to the aortic arch in a porcine model.
Linsen
Matteus A M
MA
Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Jongkind
Vincent
V
Huisman
Laurens
L
Yeung
Kak K
KK
Diks
Jeroen
J
Wisselink
Willem
W
D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery