Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany.
Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany.
PLoS One. 2024 Feb 8;19(2):e0297800. doi: 10.1371/journal.pone.0297800. eCollection 2024.
The aim of this study was to evaluate the usability of a recently developed extracorporeally-perfused cadaver model for training the angiographic management of acute arterial diseases and periprocedural complications that may occur during endovascular therapy of the lower extremity arterial runoff.
Continuous extracorporeal perfusion was established in three fresh-frozen body donors via inguinal and infragenicular access. Using digital subtraction angiography for guidance, both arterial embolization (e.g., embolization using coils, vascular plugs, particles, and liquid embolic agents) and endovascular recanalization procedures (e.g., manual aspiration or balloon-assisted embolectomy) as well as various embolism protection devices were tested. Furthermore, the management of complications during percutaneous transluminal angioplasty, such as vessel dissection and rupture, were exercised by implantation of endovascular dissection repair system or covered stents. Interventions were performed by two board-certified interventional radiologists and one resident with only limited angiographic experience.
Stable extracorporeal perfusion was successfully established on both thighs of all three body donors. Digital subtraction angiography could be performed reliably and resulted in realistic artery depiction. The model allowed for repeatable training of endovascular recanalization and arterial embolization procedures with typical tactile feedback in a controlled environment. Furthermore, the handling of more complex angiographic devices could be exercised. Whereas procedural success was be ascertained for most endovascular interventions, thrombectomies procedures were not feasible in some cases due to the lack of inherent coagulation.
The presented perfusion model is suitable for practicing time-critical endovascular interventions in the lower extremity runoff under realistic but controlled conditions.
本研究旨在评估一种新开发的离体灌注尸体模型在培训下肢动脉流出道血管内治疗中可能发生的急性动脉疾病和围手术期并发症的血管造影管理方面的可用性。
通过腹股沟和膝下途径在三个新鲜冷冻尸体供体中建立连续的体外灌注。使用数字减影血管造影术（digital subtraction angiography，DSA）作为指导，进行动脉栓塞（例如，使用线圈、血管塞、颗粒和液体栓塞剂进行栓塞）和血管内再通术（例如，手动抽吸或球囊辅助血栓切除术）以及各种栓塞保护装置的测试。此外，通过植入血管内夹层修复系统或覆膜支架，对经皮腔内血管成形术（percutaneous transluminal angioplasty，PTA）期间的并发症（如血管夹层和破裂）进行处理。干预由两名具有董事会认证的介入放射科医生和一名仅具有有限血管造影经验的住院医师进行。
所有三个尸体供体的两条大腿均成功建立了稳定的体外灌注。DSA 可以可靠地进行，并且可以得到逼真的动脉图像。该模型允许在受控环境中重复进行血管内再通和动脉栓塞程序的训练，同时具有典型的触觉反馈。此外，可以练习更复杂的血管造影设备的操作。虽然大多数血管内干预措施的程序成功率得到了确定，但在某些情况下，由于缺乏内在凝血，血栓切除术是不可行的。
所提出的灌注模型适合在真实但受控的条件下进行下肢流出道时间关键的血管内介入治疗。
