Boudghène F, Sapoval M, Bonneau M, Bigot J M
Vascular and Interventional Unit, Department of Radiology, Hôpital Tenon, Paris, France.
Circulation. 1996 Jul 1;94(1):108-12. doi: 10.1161/01.cir.94.1.108.
Treatment of aortocaval fistulae (ACFs) by open surgery is known to be a high-risk procedure. In this experimental study, we developed a percutaneous model of ACF to test a new nonsurgical method of treatment of ACF using endovascular stent grafts.
An ACF was created percutaneously in eight sheep. Via a combined venous and arterial femoral approach, angioplasty balloons were inserted to occlude the infrarenal aorta and inferior vena cava (IVC). The IVC was punctured through the lateral aortic wall with a transjugular liver biopsy needle. The fistulous tract was then dilated with an 8-mm angioplasty balloon, and the animal was heparinized. Two weeks later, a 10-mm Cragg-Endopro-Stent was inserted into the aorta at the level of the fistula via a percutaneous femoral approach. ACFs were successfully created in all animals, with rapid dye shunt through the fistula and a 20% increase in cardiac pulsations. Follow-up angiograms at 2 weeks showed a patent ACF, and stent implantation excluded the fistula in every case. Angiographic and pathological examinations up to 6 months demonstrated normal aortic patency and persistent exclusion of the fistulae.
ACFs were effectively treated by endovascular grafting of the aorta. The animal model and the stenting procedures were both performed percutaneously.
已知开放手术治疗主动脉腔静脉瘘（ACF）是一种高风险手术。在本实验研究中，我们建立了ACF的经皮模型，以测试一种使用血管内支架移植物治疗ACF的新非手术方法。
通过经皮方式在八只绵羊身上制造ACF。经股动静脉联合入路，插入血管成形球囊以闭塞肾下腹主动脉和下腔静脉（IVC）。用经颈静脉肝活检针经主动脉侧壁穿刺IVC。然后用8毫米血管成形球囊扩张瘘道，并给动物肝素化。两周后，通过经皮股动脉入路在瘘口水平将一个10毫米的Cragg-Endopro-Stent支架插入主动脉。所有动物均成功制造出ACF，造影剂通过瘘道迅速分流，心脏搏动增加20%。2周时的随访血管造影显示ACF通畅，且每种情况下支架植入均排除了瘘口。长达6个月的血管造影和病理检查显示主动脉通畅正常，瘘口持续被排除。
通过主动脉血管内植入移植物有效治疗了ACF。动物模型和支架置入手术均经皮进行。
