E-036 Cadaveric Flow Model for Endovascular Simulated Interventions
E-036 Cadaveric Flow Model for Endovascular Simulated Interventions
复制标题
E-036 用于血管内模拟干预的尸体流模型
DOI：
10.1136/neurintsurg-2014-011343.103
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发表时间：
2014
影响因子：
4.8
通讯作者：
Cox B
中科院分区：
文献类型：
--
作者：
Cox B
介绍/目的在模拟器上学习的好处早已在不同的实践领域，包括医疗行业建立。特别是最近的技术进步已经产生了流动模型或模拟器，从业者可以在这些模型或模拟器上学习新技术、评估新设备或提高他们在直接病人护理之外的技能。然而，没有一个可用的模型完全再现真实的医疗实践中遇到的复杂解剖结构和变体。此外，在MRI环境中使用这样的模型是prohibitive.The实验的目的是建立一个实际的尸体流模型，在MRI environment.Materials/methodThe具体使用目前提出的工作进行了在IMSAT MRI实验室，大学的邓迪，英国。总共使用了三具Thiel尸体在升主动脉和进一步在血管-血管循环中进行经心室入路。在胸骨左缘上方的5 cm切口后入路。随后使用经典Seldinger技术进入左心室腔，并使用荧光透视将Amplatz导丝穿入升主动脉。更换了一根5 F导管并导航至升主动脉。通过在升主动脉中注射少量造影剂记录导管的血管内位置。将Amplatz导丝导航至降主动脉近端，并通过一系列扩张器将16 F气管插管导航至升主动脉，并通过充气气管内球囊进行固定。使用荧光镜，将导管导航至左、右颈总动脉和右椎动脉。结果3例患者均建立了经脑室入路，经右颈静脉直接进入上级矢状窦，并将7 F球囊导管连接到心脏泵的抽吸组件，以恢复右心功能，避免脑肿胀。可能存在血管，并通过荧光镜检查确认。大脑血管系统的X线透视和MRI可视化可以达到MCA分叉和近端M2段的水平，前循环和整个后循环到远端P1的水平。在有限的时间内连续少量的液体灌注是可能的;在所有尸体中长时间使用后发现脑肿胀。使用单独的抽吸泵在上级矢状窦并不能防止脑肿胀和CSF外渗的注入fluid.Conclusionreproducible发展的尸体脑血管模型是可能的。该模型的主要目的是在MRI环境中用于建立术中最佳序列以及仪器开发和导航。目前该模型的局限性与缺乏血脑屏障的完整性以及随后的间质和蛛网膜下腔外渗有关。考克斯：没有。R.布丘克：没有。M.鲁布：没有。A.梅尔泽：没有。
Introduction/purposeThe benefits of learning on simulator have long been established across different areas of practice including medical industry. In particular recent technological advances have produced either flow models or simulators on which practitioners can learn new techniques evaluate new devices or improve their skills outside of direct patient care. None of the models available do however reproduce entirely the complex anatomy and variants encountered in real medical practice. Moreover the use of such models in an MRI environment is prohibitive.The purpose of this experiment was to create a practical cadaveric flow model for specific use in the MRI environment.Materials/methodThe current presented work was carried at the IMSAT MRI laboratory, University of Dundee, UK. A total of three Thiel cadavers were used for trans ventricular access in the ascending aorta and further in the cerebro-vascular circulation. The access followed a 5 cm incision over the left sternal border. Using classical Seldinger technique the left ventricle cavity was thereafter accessed and using fluoroscopy an Amplatz wire was passed into the ascending aorta. A 5F catheter was exchanged and navigated into the ascending aorta. Intravascular position of the catheter was documented by injecting a small amount of contrast in the ascending aorta. The Amplatz wire was navigated into the proximal descending aorta and by a series of dilators a, 16F endotracheal tube was navigated into the ascending aorta and secured by inflating the endotracheal balloon.Using fluoroscopy, catheters were navigated into the left, right common carotid and right vertebral arteries. The catheters were connected to a surgical heart pump with control for heart rhythm and output.In one case a direct right jugular access into the superior sagittal sinus was performed and a 7F balloon catheter was connected to a suctioning component of the heart pump in order to reproduce the right heart function and avoid brain swelling.ResultsIn all three cases the trans ventricular access was established and navigation into the cerebro-vascular vessels was possible and confirmed by fluoroscopy. The fluoroscopic and MRI visualization of cerebral vasculature was possible to the level of MCA bifurcation and proximal M2 segments, for the anterior circulation and through the entire posterior circulation to the level of distal P1. Perfusion with a continuous small amount of fluid was possible for a limited period of time; brain swelling was noticed after prolonged use in all cadavers.The use of a separate suctioning pump for the superior sagittal sinus did not prevent brain swelling and CSF extravazation of the infused fluid.ConclusionReproducible development of a cadaveric cerebrovascular model is possible. The main purpose of such model is the use in an MRI environment for establishing intra-operative optimal sequences and instrument development and navigation. Current limitations of the model are related to the lack of integrity of the blood-brain barrier and subsequent interstitial and subarachnoid extravazation.DisclosuresB. Cox: None. R. Buciuc: None. M. Rube: None. A. Melzer: None.