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Cadaveric Training Model For The Endovascular Management Of Type-b Aortic Dissection
Peter Osztrogonacz, MD, Dylan Brooks, MD, Bahar Alasti, Paul Haddad, MD, Rebecca Barnes, Stuart J. Corr, PhD, Daanish S. Sheikh, Alan B. Lumsden, MD, Maham Rahimi, MD, PhD.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: The surgical management of type-B aortic dissection (TBAD) is technically challenging, necessitating meticulous planning and execution. To enhance trainee proficiency in the managing TBAD with thoracic aortic endovascular repair (TEVAR), we have developed a cadaveric TBAD training model.
METHODS: We conducted a feasibility test using plastic tubing to simulate basic aortic anatomy. We introduced a 26 French (Fr) and a 5Fr sheath at each end. Employing a soft glidewire, we fashioned a proximal loop around the proximal segment of a Dacron graft (DG). Subsequently, the distal loop was created at the distal end of the DG using a glidewire. The DG was then carefully maneuvered through the 26Fr sheath within the simulated "aorta" by traction on the distal end of the proximal loop, which extended outward from the 5Fr sheath. Intravascular ultrasound (IVUS) was used to visualize the DG within the aorta. This methodology was subsequently replicated in a cadaveric model.
RESULTS: The in vitro test validated the concept for TBAD model creation; we proceeded to establish a cadaveric TBAD model. Access was gained to the left common carotid and right common femoral arteries, facilitating the placement of an undersized DG distal to the left subclavian artery. Angiography verified successful TBAD model creation. In the conclusive phase, a Gore cTAG endograft was deployed distal to the left subclavian artery.
CONCLUSIONS: This model demonstrated the feasibility and reproducibility of a cadaveric TBAD training model, offering an innovative tool for teaching vascular trainees the intricate of TBAD management.
Figure 1: (A) Dacron graft was deployed below the left subclavian artery, by pulling on the proximal loop (black arrow). Contrast administration excellently outlined the true (blue arrow) and false (green arrow) lumens.
(B) TEVAR graft was deployed just distal to the left subclavian artery.
(C) Following Dacron graft deployment, we performed IVUS, which demonstrated the separation of the true (#) and false (*) lumens.
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