An angioscopic method for intraluminal aortic evaluation and stent placement

Purpose: The purpose of this study was to develop an angioscopic technique to visualize the endoluminal surface of the aorta and to guide vascular stent placement. Methods: A fiberoptic angioscope, fitted with a balloon at its tip, was passed via a carotid arteriotomy into the abdominal aorta of seven anesthetized pigs. Saline solution inflation of the balloon allowed for blood displacement and clear visualization of the endoluminal anatomy. After the left renal artery orifice had been identified with angioscopy, a catheter was inserted via a left femoral sheath to cannulate the orifice under direct visualization. The position of the catheter was verified angiographically. A vascular stent was loaded onto an angioplasty balloon, inserted through a right femoral arteriotomy, positioned by use of angioscopic visualization, and deployed immediately below the left renal artery orifice. Results: The aortic trifurcation and the lumbar and renal artery orifices were clearly visualized in every animal. Vascular stents were placed in seven animals within an average of 3.14±1.14 mm (mean±SEM, range 0 to 8 mm) below the inferior rim of the left renal artery orifice. No stents were positioned above a renal artery orifice or obstructed blood flow. Conclusions: This angioscopic technique permitted detailed evaluation of aortic endoluminal anatomy and precise implantation of vascular stents. Direct endovascular visualization may facilitate other endovascular procedures, including endovascular grafting.