Echo-Endoscope Biplane Navigation System for Endovascular Aneurysm Repair

Abstract

Requirement of contrast medium limits the indication of endovascular intervention to patients with renal insufficiency and allergic reaction. Furthermore, landmarks under fluoroscopic guidance do not necessarily encompass the local anatomy of complex aortic lesions. We evaluated the feasibility of a bimodal monitoring system consisting of echocardiography and endoscopy as a more accurate anatomical navigation system for endovascular intervention. Seven domestic swine underwent intravascular monitoring of the thoracoabdominal aorta by an intraluminal echo-endoscopic device. This device consisted of a balloon-tipped endoscope for bloodless visual fields, combined with an echocardiogram to give a cross-sectional view. Anatomical landmarks, including the thoracoabdominal aorta, the conditions of the intima, and the location of the aortic branches, were readily visualized by direct vision. Simultaneously, subintimal anatomies and angles of those branches relevant to stent graft implantation were monitored by ultrasonographic cross-sectional view. Precise anatomical information of the potential landing zone can be obtained by this technique. The echo-endoscope biplane navigation system has a potential to provide anatomical information sufficient for the planning and undertaking of endovascular intervention without contrast medium.