Dual Fish Mouth Anastomosis in a Swine AVM Model: A Translational Platform for Shunt Augmentation and FFR-Guided...

Swine carotid-jugular fistula models of cerebral arteriovenous malformations (AVMs) are often limited by high rates of thrombosis and short patency duration because of restricted shunt surface area and vascular spasm. The purpose of this study was to develop a simple, durable and cost-effective AVM animal model for hemodynamic assessment of AVMs.

A modified end-to-end carotid-jugular fistula was constructed in 10 pigs using a dual fish mouth technique. An oblique-longitudinal arteriotomy was created in the right common carotid artery and the proximal left external jugular vein. Anastomosis was performed after proximal and distal vessel ligation. Intermittent balloon angioplasty was conducted every 15 minutes. Fractional flow reserve microguidewires were used to measure pressures across the arterial feeders and draining vein. Results: The model was successfully constructed in all cases (100%). Durable fistula patency was maintained in 80% (n = 8); thrombosis occurred in 2 animals and was reversed by balloon dilation. Angiography confirmed consistent collateral flow through the rete mirabile into the draining vein in all animals. The baseline mean venous pressure was 47 ± 14 mm Hg, mean arterial feeder pressure was 64 ± 14 mm Hg, and mean arterial feeder pressure-mean venous pressure gradient was 18 ± 9 mm Hg.

This refined porcine AVM model features dual fish mouth anastomosis, intermittent balloon angioplasty, and fractional flow reserve-based pressure monitoring. It provides a reliable platform for replicating AVM hemodynamics and evaluating endovascular techniques and devices.