Cadaveric training model for the endovascular management of type B aortic dissection.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.