title: New endovascular method for transvascular exit of arteries and veins: developed in simulator, in rat and in rabbit with full clinical integration.
abstract: BACKGROUND
  Endovascular technique has benefits vis-a-vis surgical access to organs with less accessible anatomical locations. To minimize surgical risk we propose a novel endovascular technique, to create parenchymal access through endovascular methods.
  
  
  RESULTS
  We have developed, manufactured and tested an endovascular catheter with a depth limiting collar and a penetrating tip that is used to perforate vessels, thereby creating a working channel to the extra-vascular space. Computer simulations and subsequent interventions have been performed ex vivo and in vivo in both small and large animals by testing different prototypes. All tests were designed for testing extravascular hemostasis and absence of thrombo-embolic complications when exiting the vessels from the inside to the extra vascular space. We have deposited prototypes after intervention in vascular walls over a period of 14 days in rat with no impairment on blood flow and no signs of thrombo-embolic complications upon re-exploration (n = 7). We have also incorporated the catheter system with clinically available systems both in an ex vivo simulator setting and in a full scale clinical angiographical setting in rabbit were no bleeding (0%) in any of the interventions performed (n = 40). To prevent hemorrhage during termination of the procedure, a hollow electrolysis detachment-zone leaves the distal tip in the vessel-wall after the intervention. This has also been tested with absolute hemostasis in large animals (n = 6).
  
  
  CONCLUSIONS
  We have developed and tested a new system for transvascular tissue access in simulations, ex vivo and in vivo in small and large animals, integrating it with standard clinical catheters and angiographical environment, with absolute hemostasis and without thromboembolic complications. In a clinical setting for stem cell transplantation, local substance administration or tissue sampling, the benefit should be greatest in organs that are difficult or high-risk to access with other techniques, such as the pancreas, the central nervous system (CNS) and the heart.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Lundberg
authors.forename: Stefan
authors.initials: S
authors.lastname: Jonsson
authors.forename: Staffan
authors.initials: S
authors.lastname: Holmin
mesh_terms: D015901:Angiography, Digital Subtraction; D000818:Animals; D001158:Arteries / Q000473:pathology / Q000601:surgery*; D003198:Computer Simulation; D008866:Microsurgery; D011817:Rabbits; D051381:Rats; D012039:Regional Blood Flow; D014656:Vascular Surgical Procedures / Q000379:methods*; D014680:Veins / Q000473:pathology / Q000601:surgery*
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