Thrombectomized Cadavers: An Optimal Endovascular Training Method

Abstract

Create a model applicable to endovascular arterial and venous interventional skill training. A highly clinically relevant model is optimal for training, both vascular residents and practicing surgeons. While expensive, cadavers remain best to rehearse imaging, navigation, and device use. We conducted one of the largest hands-on training events, purely using a thrombectomized cadavers. We share lessons learned permitting every vascular bed to be used. Ten fresh cadavers (<6 weeks) were used. Procedure sequence was carefully designed not to compromise subsequent device deployment. Cadaver preparation (by trainees) included the following. (1) Bilateral ultrasound-guided arterial and venous femoral access. (2) Wires advanced using standard and wire and catheter techniques into the aorta/carotid/visceral vessels/IVC/Pulmonary arteries, depending on module (3) Thrombus removed from the aorta and iliac arteries using Zelante (Angiojet) catheter. (4) Perform hand injection using 25% contrast (or CO2 or air), select appropriate imaging technique, Angiojet also used for removal of contrast. (5) Warm water flushes used post nitinol device deployment. Lower extremities: (6) Access common femoral artery vie cut down. (7) Place 55-cm 7F sheath into either commons femoral or superficial femoral, loop up over the abdominal wall and cover with drapes, simulating contralateral access. Upper extremities: (8) Cut down on the basilic vein and (9) Access innominate veins retrograde. Procedure sequence (module 1) included transfemoral carotid stents and embolization protection device deployment, and stenting of the supra-aortic trunks. Module 2 comprised thoracic and abdominal aortic stent grafting. Module 3 included lower extremity intervention (set up described elsewhere in this abstract). Module 4 comprised inferior vena cava (IVC) thrombectomy, IVC filter placement, removal of IVC filter, and iliac vein stunting. Module 5 encompassed percutaneous arteriovenous fistula, and stenting of the innominate veins. Fig 1 shows a thrombectomy catheter being used to aspirate contrast after iliac venogram. Fig 2 shows a renal arteriogram in a cadaver model before peripheral renal coil embolization and orificial stenting. All prescribed procedures could be performed in all the cadavers. Although expensive ($1200/cadaver), other than live patients, there is little else that provides a high degree of clinical relevance and challenges. Thrombus removal can be successfully performed using relevant clinical techniques. This then permits the interventional sequence outlined in every vascular bed and makes the use of cadavers a reasonably cost effective in an optimal 2.5-day training paradigm.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)