AORTOSCOPY - A GUIDANCE-SYSTEM FOR ENDOLUMINAL AORTIC-SURGERY

Purpose: The aim of this project was to evaluate the feasibility of ao rtoscopy for guidance of endoluminal aortic procedures and to determin e whether aortoscopy has advantages over fluoroscopy in a pig model. M ethods: To establish feasibility aortoscopic guidance was used for mak ing endoluminal aortic measurements, cannulating small arteries for ar teriograpy, and placing intraaortic stents and grafts in 11 pigs. To c ompare aortoscopy and fluoroscopy measurements were made and stents we re placed by a surgeon using only aortoscopic guidance in 10 pigs and by an interventional radiologist using only fluoroscopic guidance in 1 0 pigs. Postmortem dissections were performed to determine measurement and device placement accuracy. Results: In the feasibility study aort oscopic measurements differed from postmortem measurements by a mean d istance (+/- SD) of 1.2 +/- 0.2 mm. Stents and grafts were placed a me an of 2.3 +/- 1.9 mm distal to the most inferior renal artery with no stent covering an orifice. All attempts at-cannulating spinal arteries greater than 2 mm in diameter were successful. In the comparison of a ortoscopic and fluoroscopic guidance, fluoroscopic measurements differ ed from postmortem measurements by 2.6 +/- 2.4 mm (p = 0.223). Stents placed with aortoscopic guidance were 1.1 +/- 1.3 mm distal to the mos t inferior renal artery, whereas stents placed with fluoroscopic guida nce were 3.4 +/- 2.5 mm distal to the most inferior renal artery (p = 0.019). Conclusions: These results demonstrate that aortoscopy is a us eful guidance system for endoluminal aortic procedures and may have ad vantages over fluoroscopy alone.