Endovascular abdominal aortic stent placement by a videoscopic ultrasound-guided technique: evaluation in a porcine model.

Purpose: To evaluate videoscopic ultrasonography (VUS) as a guiding method for endovascular aortic stent placement.

Methods: Eight pigs were prepared for a videoscopic approach to the abdominal aorta. Through the trocarts, a VUS probe was placed in contact with the infrarenal aorta and iliacs. In the first 4 animals, a standard surgical approach was used to gain access to the right femoral artery. In the last 4 animals, 1 extra 5-mm port was positioned to provide a right arterial iliac access; thus, the approach for the endovascular procedure and for perioperative VUS guidance were therefore, totally videoscopic. In both approaches, under continuous perioperative VUS guidance, a guidewire was positioned upstream to the renal arteries. Then, a balloon expandable stent was deployed just below the lowest renal artery. All the VUS dynamic images were recorded on video. The pigs were euthanized and the infrarenal aorta was harvested to check that the stent had been positioned correctly.

Results: The endovascular procedures were completed successfully in all animals. There were no bleeding complications in the 2 groups of animals and no mismatch between the aortic diameters and the selected balloon/stent sizes. All the stents were deployed 1 to 3 mm below the lowest renal artery.

Conclusions: VUS proved an excellent imaging technique for guiding abdominal endovascular procedures on pigs. After further evaluation, this method could be applied in human beings during videoscopic vascular interventions or as a specific imaging method in the future with the development of endovascular procedures by videoscopic approaches.