FREQUENCY OF AORTIC MISCANNULATION DURING FLUOROSCOPY-FREE ENDOVASCULAR NAVIGATION

Area of Science:

• Vascular Surgery
• Medical Simulation
• Interventional Radiology

Background:

• Aortic wire cannulation is sometimes performed without fluoroscopy for speed.
• The risk of guidewire misplacement (miscannulation) during these procedures is not well-quantified.

Purpose of the Study:

• To quantify guidewire misplacement rates during fluoroscopy-free aortic cannulation.
• To assess the impact of patient age on miscannulation risk.

Main Methods:

• Used human cadavers and an electronic endovascular simulator (Mentice VISTG5).
• Validated simulator accuracy with cadaveric data.
• Analyzed 89 Trauma CT Angiography scans to model vascular variability.
• Measured miscannulation frequency using repeated simulator passes.

Main Results:

• Aortic miscannulation occurred in 12% of passes in cadavers and the simulator.
• In a larger electronic simulation cohort, 36% of subjects experienced miscannulation (10%±18% frequency per pass).
• Miscannulation rates were higher in subjects over 50 years old (16%±22%) compared to younger subjects (5%±11%).
• Common misplacement sites included iliac, celiac, and superior mesenteric arteries.

Conclusions:

• Fluoroscopy-free aortic cannulation is linked to significant miscannulation risks, particularly in older individuals.
• Routine fluoroscopic confirmation or advanced endovascular devices are recommended to mitigate complications.