https://digitalcommons.unmc.edu/emet_posters/1013/thumbnail.jp

Aylward, Paul

Kamenskiy, Alexey

MacTaggart, Jason N.

Marmie, Blake

Sanderfer, Christian

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

University of Nebraska Medical Center DigitalCommons@UNMC EMET Posters College of Medicine Students 2020 Feasibility of Fluoroscopy-Free Endovascular Navigation in Subjects of Different Ages Blake Marmie Christian Sanderfer Paul Aylward Alexey Kamenskiy Jason N. MacTaggart Follow this and additional works at: https://digitalcommons.unmc.edu/emet_posters  Part of the Medical Education Commons Fluoroscopy-free endovascular navigation has received significant attention due to its utility for controlling hemorrhage in pre-hospital settings. Morphometric vascular maps have been proposed to accurately calculate catheter and wire lengths to reach specific aortic zones without the need for fluoroscopy. It remains unclear whether certain anatomical characteristics, such as wide bifurcation angles or vessel tortuosity that are particularly prevalent in older subjects, may prevent fluoroscopy-free navigation. Our goal was to test the ability to blindly navigate the aorta with a stiff 0.035” and J-curve wires using electronic simulator.METHODSA total of n=86 CTAs from trauma patients 5-93 years old (averageage 53±2 years) were used to build 3D models of the aorta andits branches using Mimics software. The models were exportedinto Mentice VIST G5 simulator through the Case-IT capability. Anelectric wire-feeding mechanism was built to advance J-curve and0.035” 35deg wires at a consistent speed, and a total of 6 trialswere performed in each anatomy and with each of the wires.Final location of the wire was recorded and percentage ofunsuccessful attempts to advance the wire from the femoralaccess site to Zone 1 was calculated.DISCUSSIONAging is associated with increased wire misplacements across all the major aortic branches. Themost common misplacement locations are iIIA and cCIA. No misplacements were observed in20-29-year-old anatomies for either of the wires. After the age of 50 years, misplacementsbecome more common, particularly when using the 0.035” 35deg wire, most likely due toincreased aortic tortuosity and widening of the aortoiliac bifurcation with age. Presented resultssuggest that fluoroscopy-free endovascular navigation may be feasible in subjects younger than50-years-of-age (<5% misplacements), but the risk more than doubles in older subjects.INTRODUCTIONFeasibility of Fluoroscopy-Free Endovascular Navigation in Subjects of Different AgessIn majority of cases both wires stayed in the aorta as they were blindly advanced towards the heart. The overall frequency of misplacements increased with age for both wires (P=0.04 for J-curve and P=0.04 for 0.035”wire respectively, Figure 1). With J-curve misplacements occurred in <9year-old-group (contralateral common iliac artery [cCIA], 3%), in 30-39-year-old group (ipsilateral internal iliac artery [iIIA], 3%) and in >50-year-old groups (cCIA, iIIA, subclavian, celiac arteries, with up to 7%, 5%, 1%, and 1% respectively). With 0.035” wire misplacements occurred in all age groups except 20-29-year-old. In subjects <50-years-old misplacements occurred in iIIA (1-5%), while in older subjects misplacements were most common in cCIA (up to 11%), followed by iIIA (10%), celiac (3%), renal (2%), and superior mesenteric artery (1%).Blake Marmie BS, Christian Sanderfer BS, Paul Aylward MD, Alexey Kamenskiy PhD, Jason MacTaggart, MD, (1) Department of Surgery, University of Nebraska Medical center, Omaha, NE, 68198RESULTS

Feasibility of Fluoroscopy-Free Endovascular Navigation in Subjects of Different Ages

https://digitalcommons.unmc.edu/cgi/viewcontent.cgi?article=1013&context=emet_posters

Feasibility of Fluoroscopy-Free Endovascular Navigation in Subjects of Different Ages

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