Frequency Of Aortic Miscannulation During Fluoroscopy-Free Endovascular Navigation

BackgroundAortic wire cannulation is sometimes performed without the assistance of fluoroscopy for expediency, but the associated risk of miscannulation has not been quantified. We used human cadavers and an electronic endovascular simulator to characterize guidewire misplacement rates during attempted fluoroscopy-free cannulation of the descending thoracic aorta. MethodsAortic cannulation was done in perfused human cadavers (n=10, age 81{+/-}13 years) and in their vascular anatomies loaded into the Mentice VISTG5 simulator to validate the method. Trauma Computerized Tomography Angiography scans (n=89, age 47{+/-}24 years, range 5-93 years) were used to build 3D vascular models and assess morphometric variability in vessel tortuosity, length, and branch angulations. Aortic miscannulation frequency was measured using an electronic simulator with multiple passes using a wire-feeding mechanism, and the results were analyzed in the context of age. ResultsAortic miscannulation was the same in cadavers as in the electronic simulator (12%) for all passes. Electronic simulation using a larger cohort demonstrated that miscannulations occurred in 36% of all subjects, and the frequency for all passes was 10{+/-}18%. Aortic miscannulation frequency was lower in <50-year-old subjects (5{+/-}11%) than in >50-year-old subjects (16{+/-}22%), and the most frequent misplacement locations were into the iliac (5%), celiac (2%), and the superior mesenteric arteries (1%). ConclusionsFluoroscopy-free aortic cannulation may be associated with significant miscannulation rates, particularly in subjects older than 50 years. Fluoroscopic confirmation of wire location or endovascular devices capable of detecting and avoiding aortic miscannulation may reduce aortic access complications.