Angioscope-assisted endovascular occlusion of venous tributaries: preclinical studies

The feasibility of angioscope-assisted occlusion of venous tributaries from within a vein using a steerable 'shaped-memory' nickel-titanium (nitinol) alloy catheter and occlusion coils was evaluated. An initial series of tests was designed to establish the necessary pressure (275 p.s.i., 1897.5 kPa), time (1.5 s) and volume (2.5 ml normal saline) requirements for hydraulic delivery of platinum occlusion coils from the nitinol catheter through a 3-Fr tracking catheter. In a second series, 25 side branches of the saphenous vein in 11 amputated limbs were visualized angioscopically and cannulated with the nitinol catheter under angioscopic and fluoroscopic surveillance to determine whether the catheter tip could be positioned and coils deployed. In a third series of studies, ten canine femoral vein tributaries were successfully cannulated with an 8-Fr nitinol catheter and 19 occlusion coils delivered under angioscopic surveillance. Fluoroscopy verified coil placement and all embolized venous tributaries were thrombosed. An ideal approach for femoropopliteal in situ saphenous vein bypass would allow the surgeon to divide saphenous vein valves while occluding venous side branches from within the saphenous vein. These initial studies demonstrate that the nitinol catheter can occlude venous tributaries from within a vein by coil embolization. Further development of this technique for clinical investigation is warranted.