Aortoscopy: A guidance system for endoluminal aortic surgery

Purpose: The aim of this project was to evaluate the feasibility of aortoscopy for guidance of endoluminal aortic procedures and to determine whether aortoscopy has advantages over fluoroscopy in a pig model. Methods: To establish feasibility aortoscopic guidance was used for making endoluminal aortic measurements, cannulating small arteries for arteriograpy, and placing intraaortic stents and grafts in 11 pigs. To compare aortoscopy and fluoroscopy measurements were made and stents were placed by a surgeon using only aortoscopic guidance in 10 pigs and by an interventional radiologist using only fluoroscopic guidance in 10 pigs. Postmortem dissections were performed to determine measurement and device placement accuracy. Results: In the feasibility study aortoscopic measurements differed from postmortem measurements by a mean distance (±SD) of 1.2 ± 0.2 min. Stents and grafts were placed a mean 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 aortoscopic and fluoroscopic guidance, fluoroscopic measurements differed 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 most inferior renal artery, whereas stents placed with fluoroscopic guidance were 3.4 ± 2.5 mm distal to the most inferior renal artery (p = 0.019). Conclusions: These results demonstrate that aortoscopy is a useful guidance system for endoluminal aortic procedures and may have advantages over fluoroscopy alone.