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Challenges of Selective Catheterization across the Aortic Bifurcation with different Endografts
Yu-Ting Li, MS1, Mithun G. Jacob, MSE1, Alan Sawchuk, MD2, Michael P. Murphy, MD2, Juan P. Wachs, PhD1, A. George Akingba, MD, PhD2.
1Purdue University, West Lafayette, IN, USA, 2Indiana University School of Medicine, Indianapolis, IN, USA.
OBJECTIVES: Concomitant PAD exists in 20% of AAA patients and endovascular approaches for these patients following an EVAR are limited. Typical approaches requiring contralateral femoral access are inadequate because conventional endografts create an elevated neo-bifurcation of the iliac limbs with a hyperacute angle (HA) which makes selective catheterization difficult. We hypothesize that endografts that are seated on the native aortic bifurcation (NAB) present less acute angulation and thus require less force to track a catheter into the ipsilateral limb. We compared selective catheterization of two types of endograft [(1) preserved the NAB, and (2) with a HA] by measuring technical success of tracking a catheter across the bifurcation and variance of guidewire displacement as a surrogate for catheter buckling.
METHODS: Two experimental conditions were conducted to evaluate the amount of buckling observed when tracking the catheter across the bifurcation of two types of endografts. The first was with the guidewire in the ipsilateral limb not pinned while the second was with the wire pinned. The endografts and guidewires were manually deployed into an AAA glass model. A camera was mounted overhead and images used to automatically measure variance of guidewire displacement in the XY-plane from the ipsilateral endograft limb. A robotic arm was programmed to track the catheter over the guidewire with a constant translational velocity of 2.5 cm/sec.
RESULTS: A total of 20 trials were performed on each experimental condition. For condition 1, 100% successful attempts at selective catheterization of the aortic bifurcation using the NAB endograft was achieved and 0% success with the HA endograft. The mean variance of the guidewire displacement when tracking a catheter using the NAB endograft was 2.81 ± 1.27-cm2 and 52.23 ± 22.89-cm2 for the HA endograft (p < 0.001). For condition 2 (with the contralateral wire pinned), 100% successful attempts at selective catheterization of the aortic bifurcation using the NAB endograft was achieved and 75% success with the HA endograft. The mean variance of the guidewire displacement using the NAB endograft was zero and 0.006 ± 0.01-cm2 for the HA endograft (p < 0.01).
CONCLUSIONS: Selective catheterization of the aortic bifurcation of an endograft has a higher success rate with a NAB endograft compared with the HA endograft. This holds true even when the wire is pinned.
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