Direct videoscopic approach to the descending thoracic aorta for aortic arch endograft delivery: Evaluation in a porcine model

Purpose: To examine the feasibility of a direct videoscopic approach to the descending thoracic aorta for enclograft delivery to the aortic arch. Methods: A double purse-string suture was placed on the aorta of 3 pigs via a thoracoscopic approach. Subsequently, the aorta was cannulated in the center of the purse-string. A 22-F delivery catheter was advanced under fluoroscopic control over a guidewire via a trocar into the proximal aorta. After deployment of a tubular endograft, the catheter was withdrawn from the aorta while simultaneously tightening the purse-string suture, without aortic cross clamping. The outcome was evaluated by post implant angiography and autopsy results. Results: The procedure was successfully completed in all animals, with a mean total procedure time of 126 minutes (range 118-137). Mean enclograft implantation time from needle puncture to catheter extraction was 27 minutes (range 21-37). Hemostasis was obtained in all animals after withdrawal of the delivery catheter and tightening the purse-string suture. The mean blood loss was 143 mL (range 80-220). Autopsy proved all purse-string sutures to be adequately placed and all endografts deployed in the correct position. Conclusion: A direct videoscopic approach to the descending thoracic aorta proved a feasible technique for enclograft delivery to the aortic arch in a porcine model.