Modification of a Previously Described Arteriovenous Malformation Model in the Swine: Endovascular and Combined Surgical/Endovascular Construction and Hemodynamics
Ralf Siekmanna,
Ajay K. Wakhloo
,a,
Baruch B. Liebera,
Matthew J. Gounisa,
Afshin A. Divania and
L. Nelson Hopkinsa
a From the Toshiba Stroke Research Center, Department of Neurosurgery (R.S., A.K.W., B.B.L., L.N.H.), and the Department of Mechanical and Aerospace Engineering (B.B.L., M.J.G., A.A.D.), State University of New York at Buffalo, Buffalo, New York, and the Section of Interventional Neuroradiology (A.K.W.), University of Miami School of Medicine, Miami, FL.
View larger version (38K):
[in a new window]
|
FIG 1. Schematic illustration of the simplified AVM model in swine. Large arrows indicate the direction of blood flow through the rete mirabile. A 6F-guide catheter is tightly fit into the left APA beyond the origin of the OA and serves as the venous segment of the AVM model. The CCA is surgically ligated proximal to the guide catheter. The proximal end of the catheter is opened to reduce the pressure and drives the blood toward the collection basin. A microcatheter placed in the right APA serves as the arterial side of the AVM model (Note.—RCCA = right CCA; RAPA = right APA; RFA = right femoral artery; MB = muscular branch of the APA).
The inset (A) shows the surgical preparation of the AVM model in swine as previously described by Massoud et al (1). The arteriovenous fistula and the endovascularly placed balloon within the ECA (empty arrow) promotes the blood flow from the right APA into the left jugular vein (arrows).
| |
View larger version (142K):
[in a new window]
|
FIG 2. A, Left APA angiogram in right oblique projection obtained using a 6F catheter after occlusion of the CCA with a nondetachable 9.4F balloon catheter. The contrast agent injection was performed to demonstrate the complete occlusion of the CCA and the ECA with the balloon and the exact placement of the 6F guiding catheter within the APA.
B, Nonsubtracted angiogram of the same animal as in A shows the contrast agent–filled occlusive balloon in the left CCA.
| |
View larger version (115K):
[in a new window]
|
FIG 3. A, Right APA angiogram in anteroposterior and submentooccipital projection of the arteriovenous shunt through the rete mirabile. Contrast material was administrated using an injector pump with preset parameters (injection speed, 1 mL/s; maximal injection pressure, 20 atm). There is a complete opacification of the ipsilateral (right) and only a partial opacification of the contralateral (left) rete.
B, Angiogram after opening the draining catheter on the left side; same animal and same injection parameters as in A. The left APA is apparent and the contrast agent–filled guide catheter represents the extended venous segment of the AVM.
| |
