Zhong Qian MD, Presenter: Nothing to Disclose

Jorge Lopera MD, Abstract Co-Author: Nothing to Disclose

Manuel Maynar MD, Abstract Co-Author: Nothing to Disclose

Rafael Llorens MD, Abstract Co-Author: Nothing to Disclose

Ruizhong Li MD, Abstract Co-Author: Nothing to Disclose

Wilfrido Rolando Castaneda-Zuniga MD, Abstract Co-Author: Nothing to Disclose

To describe the endovascular placement of an extraluminal bypass graft (EPEBG) in experimental animals and cadaver legs.

The technique was tested in the superficial femoral artery (SFA) of 3 dogs. The mid SFA was embolized with coils to mimic SFA occlusion. The proximal and distal SFA were then punctured via the carotid and distal SFA accesses repectively, 6 cm apart using both a modified 20 cm long Chiba needle (distal puncture) and a modified stiff wire/needle (proximal puncture). These two separate punctures were selected as the sites for connection to the 7x10cm Hemobahn that was used to establish the EPEBG. The animals were angiographically followed up for 6 months.The EPEBG was also undertaken in 3 cadaver legs specially preserved to retain the tissue texture and patent vascular lumen. Following a percutaneous access to the popliteal artery (PA), a Rosch-Uchida needle was used to perforate the vascular wall at the level of the PA, followed by the creation of an extraluminal tract along the neurovascular bundle. Once the desired level was reached the needle was again used to perforate through the vascular wall of the proximal SFA. Hemobahn grafts were then deployed to establish the extraluminal F-P bypass connecting the two arterial puncture sites.

EPEBP was successfully created in all animal and cadaver subjects. In the animal study, one graft remained patent at 6 mos before euthanasia; one was found patent at 3 mos, but occluded at 6 mos; and the third was found occluded at 1 mo. Necropsy found thrombosis of the distal SFA. Mismatch in diameter between the distal SFA and graft was a problem in the animals. Only procedure-related complication was hematoma developed at arterial puncture sites. In the cadaver study angiography revealed a patent graft in all three cases. The macroscopic examination showed no evidence of kinking or damage to adjacent nerves, arteries or veins along the bypass extraluminal tract and puncture sites.

The EPEBG is technically feasible in the canine and cadaver models. Less complications are expected as improvements are made in instrument and graft design including a working sheath with an occlusion balloon and tapered grafts.

Qian, Z, Lopera, J, Maynar, M, Llorens, R, Li, R, Castaneda-Zuniga, W, Endovascular Placement of an Extraluminal Bypass Graft in the Superficial Femoral Artery: Results from Animal and Cadaver Study.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4416120.html