title: Direct videoscopic approach to the descending thoracic aorta for aortic arch endograft delivery: evaluation in a porcine model.
abstract: 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 After deployment of a tubular endograft, the catheter was withdrawn from the aorta while simultaneously tightening the purse-string suture, without aortic cross clamping.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.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Matteus A M
authors.initials: MA
authors.lastname: Linsen
authors.forename: Vincent
authors.initials: V
authors.lastname: Jongkind
authors.forename: Laurens
authors.initials: L
authors.lastname: Huisman
authors.forename: Kak K
authors.initials: KK
authors.lastname: Yeung
authors.forename: Jeroen
authors.initials: J
authors.lastname: Diks
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
mesh_terms: 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