title: Direct videoscopic approach to the thoracic aorta for aortic endograft delivery: evaluation in a human cadaver circulation model.
abstract: OBJECTIVE
  To examine the feasibility of a direct videoscopic approach to the descending thoracic aorta for branched endograft delivery to the aortic arch and abdominal aorta.
  
  
  METHODS
  Aneurysms were created in the aortic arch and pararenal aorta of 3 human cadavers, and pulsatile flow was established using a roller pump. Thoracoscopically, 2 double-felted purse-string sutures were placed on the thoracic aorta. Via the most distal trocar, an endoscopic needle was used to insert a stiff guidewire into the aorta through the center of the purse-string suture. Under direct videoscopic control, a 20-F sheath was advanced over the wire into the aorta. Switching to fluoroscopic control, a fenestrated endograft was deployed in the aortic arch followed by placement of a branch graft into the left subclavian artery. The delivery sheath was withdrawn from the aorta while simultaneously tightening the purse-string sutures. A similar procedure was performed in the same cadaver for antegrade branched endograft delivery to the pararenal aorta. Correct deployment of the branched endografts was evaluated by post implant angiography and autopsy.
  
  
  RESULTS
  The procedure was successfully completed in all cadavers. "Hemostasis" was obtained in all cadavers without aortic cross clamping. Median fluid loss was 165 mL. Autopsy proved all purse-string sutures to be adequately placed and all branched endografts to be deployed in the correct position.
  
  
  CONCLUSIONS
  A direct videoscopic approach to the descending thoracic aorta proved a feasible technique for branched endograft delivery to the aortic arch and abdominal aorta in a human cadaver model.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam 1007 MB, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jongkind
authors.forename: Kak K
authors.initials: KK
authors.lastname: Yeung
authors.forename: Matteus A M
authors.initials: MA
authors.lastname: Linsen
authors.forename: David
authors.initials: D
authors.lastname: Heidsieck
authors.forename: Hans M E
authors.initials: HM
authors.lastname: Coveliers
authors.forename: Arjan W J
authors.initials: AW
authors.lastname: Hoksbergen
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001344:Autopsy; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D056888:Patient Positioning; D011474:Prosthesis Design; D011673:Pulsatile Flow; D015641:Radiography, Interventional; D015607:Stents; D013536:Suture Techniques; D020775:Thoracic Surgery, Video-Assisted