Osztrogonacz Peter, Sheikh Daanish, Brooks Dylan, Alasti Bahar, Haddad Paul, Barnes Rebecca, Corr Stuart J, Lumsden Alan B, Safadi Kamal, Burns Robert, Rahimi Maham
Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX.
Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary.
J Vasc Surg Cases Innov Tech. 2025 Jul 11;11(6):101916. doi: 10.1016/j.jvscit.2025.101916. eCollection 2025 Dec.
The surgical management of type-B aortic dissection (TBAD) poses considerable technical challenges, necessitating meticulous planning and precise execution. In an effort to enhance the proficiency of trainees in the management of TBAD through thoracic aortic endovascular repair, we have developed a cadaveric TBAD training model.
We conducted a feasibility test using a plastic tube designed to simulate the basic anatomical characteristics of the aorta. To access the interior of the tube, we introduced a 26 Fr and a 5 Fr sheath at each end. Employing a soft glidewire, we fashioned a proximal loop around the proximal segment of a Dacron graft (DG). Subsequently, a distal loop was created at the distal end of the DG using a glidewire. The DG was then carefully maneuvered through the 26 Fr sheath within the simulated "aorta" by traction on the distal end of the proximal loop, which extended outward from the 5 Fr sheath. Finally, visualization of the DG within the "aorta" was achieved using an intravascular ultrasound catheter. This methodology was subsequently replicated in a cadaveric model, as detailed in the following section.
The in vitro feasibility test substantiated the viability of the devised concept for TBAD model creation. Encouraged by these findings, 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, employing the previously described methodology. Completion angiography verified the successful creation of the TBAD model. In the conclusive phase, a Gore cTAG endograft was deployed distal to the left subclavian artery.
The presented model not only demonstrated the feasibility of our conceptual approach for TBAD training model creation but also underscored the potential reproducibility of a cadaveric TBAD model. This innovative educational tool holds promise for effectively instructing vascular trainees in the intricate nuances of surgical management for TBAD.
B型主动脉夹层（TBAD）的外科治疗面临着巨大的技术挑战，需要精心规划和精确执行。为了提高学员通过胸主动脉腔内修复术管理TBAD的熟练度，我们开发了一种尸体TBAD训练模型。
我们使用一根设计用于模拟主动脉基本解剖特征的塑料管进行了可行性测试。为了进入管内，我们在两端分别插入了一个26F和一个5F的鞘管。使用一根柔软的导丝，我们在涤纶移植物（DG）的近端段周围形成了一个近端环。随后，使用导丝在DG的远端创建了一个远端环。然后，通过拉动从5F鞘管向外延伸的近端环的远端，小心地将DG通过模拟“主动脉”内的26F鞘管进行操作。最后，使用血管内超声导管实现了对“主动脉”内DG的可视化。如下所述，该方法随后在尸体模型中进行了复制。
体外可行性测试证实了所设计的TBAD模型创建概念的可行性。受这些发现的鼓舞，我们继续建立了一个尸体TBAD模型。通过左颈总动脉和右股总动脉进行入路，采用先前描述的方法，便于在左锁骨下动脉远端放置一个尺寸过小的DG。完成血管造影证实了TBAD模型的成功创建。在最后阶段，在左锁骨下动脉远端部署了一个戈尔cTAG腔内移植物。
所展示的模型不仅证明了我们创建TBAD训练模型的概念方法具有可行性，还强调了尸体TBAD模型的潜在可重复性。这种创新的教育工具有望有效地指导血管外科培训学员掌握TBAD手术管理的复杂细微差别。
