Angioscopic Evaluation of an Endoluminal Aortic Graft: The First Clinical Experience

Abstract

Purpose: Balloon aortoscopy has been described for viewing aortic endoluminal anatomy and guiding aortic stent placement in animals. We report the first clinical use of this technique to visually inspect the proximal portion of a 1-year-old endovascular aortic graft, its proximal fixation stent, and its relationship to the renal arteries. Methods: The aortoscope is a modified fiber-optic endoscope that is fitted over the lens with a transparent, saline-filled balloon for blood displacement. Its performance was evaluated in a 62-year-old woman who had a Parodi-type Dacron/modified Palmaz stent endoluminal graft implanted to exclude an infrarenal aortic aneurysm in 1994. One year later, during an angioplasty procedure for symptomatic left subclavian and left common iliac artery stenoses, the 1-year-old endoluminal graft was inspected with the balloon-tipped angioscopic assembly. Results: Introduced via the left brachial artery, the aortoscope provided a panoramic view of the endoluminal surface through the solution-filled balloon. The endoluminal aortic graft was clearly identified, as were both renal artery orifices proximal to the graft. The surface of the proximal stent was smooth and without exposed metal. No complications occurred with the angioscopy technique. Conclusions: Aortic angioscopy can be used to evaluate endoluminal aortic grafts and endoluminal anatomy. It provides clear, magnified views that may be useful for guiding precise placement and assessing the function and healing of endoluminal devices in the aorta.