EUS-guided angiography: a novel approach to diagnostic and therapeutic interventions in the vascular system.
BACKGROUND
Indications for diagnostic and therapeutic procedures under EUS guidance continue to expand.


OBJECTIVE
To assess the feasibility and safety of EUS-guided angiography in a live porcine model.


METHODS
Five acute experiments under general anesthesia.


METHODS
A linear echoendoscope was advanced into the stomach. Thoracic and abdominal aorta, celiac axis, superior mesenteric and splenic artery, splenic, portal, and hepatic veins were injected with contrast by using FNA needles under fluoroscopy. The animals were then killed for postmortem examination.


METHODS
Ability to achieve angiography without complications.


RESULTS
All vessels were identified and punctured without technical difficulties. Injections of the large-caliber vessels resulted in a blush of contrast, whereas selective injection of the smaller vessels (splenic artery, hepatic veins) demonstrated clear vascular opacification. Injection of contrast was technically easiest with the 19-gauge FNA needle and most difficult with the 25-gauge needle. There were no changes in vital signs and hemodynamic parameters during vascular injection of any vessel. At necropsy, the 25-gauge FNA needle did not cause any visible vascular injury or bleeding. The 22-gauge needle left a visible puncture mark without active bleeding. In 1 of 5 pigs, the 19-gauge needle caused a localized vascular hematoma around large-caliber vessels and 150 mL of intra-abdominal blood.


CONCLUSIONS
Technical challenges remain to achieve an adequate flow rate of contrast for prolonged visualization of large vessels.


CONCLUSIONS
EUS-guided angiography is technically easy and safe and has potential for a wide array of diagnostic and therapeutic vascular interventions.
Magno
Priscilla
P
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA, and Division of Gastroenterology, National Yang-Ming University, Taipei, Taiwan.
Ko
Chung-Wang
CW
Buscaglia
Jonathan M
JM
Giday
Samuel A
SA
Jagannath
Sanjay B
SB
Clarke
John O
JO
Shin
Eun Ji
EJ
Kantsevoy
Sergey V
SV
D000792:Angiography / Q000379:methods*; D000818:Animals; D001027:Aortography / Q000379:methods; D044963:Biopsy, Fine-Needle / Q000295:instrumentation; D003287:Contrast Media / Q000008:administration & dosage; D019160:Endosonography / Q000379:methods*; D005471:Fluoroscopy; D011677:Punctures; D013552:Swine; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional / Q000379:methods*
D003287:Contrast Media