Human Thiel-Embalmed Cadaveric Aortic Model with Perfusion for Endovascular Intervention Training and Medical Device Evaluation

Abstract

PurposeThe purpose of this investigation was to evaluate human Thiel-embalmed cadavers with the addition of extracorporeal driven ante-grade pulsatile flow in the aorta as a model for simulation training in interventional techniques and endovascular device testing.Materials and MethodsThree human cadavers embalmed according to the method of Thiel were selected. Extracorporeal pulsatile ante-grade flow of 2.5 L per min was delivered directly into the aorta of the cadavers via a surgically placed connection. During perfusion, aortic pressure and temperature were recorded and optimized for physiologically similar parameters. Pre- and post-procedure CT imaging was conducted to plan and follow up thoracic and abdominal endovascular aortic repair as it would be in a clinical scenario. Thoracic endovascular aortic repair (TEVAR) and endovascular abdominal repair (EVAR) procedures were conducted in simulation of a clinical case, under fluoroscopic guidance with a multidisciplinary team present.ResultsThe Thiel cadaveric aortic perfusion model provided pulsatile ante-grade flow, with pressure and temperature, sufficient to conduct a realistic simulation of TEVAR and EVAR procedures. Fluoroscopic imaging provided guidance during the intervention. Pre- and post-procedure CT imaging facilitated planning and follow-up evaluation of the procedure.ConclusionThe human Thiel-embalmed cadavers with the addition of extracorporeal flow within the aorta offer an anatomically appropriate, physiologically similar robust model to simulate aortic endovascular procedures, with potential applications in interventional radiology training and medical device testing as a pre-clinical model.Electronic supplementary materialThe online version of this article (doi:10.1007/s00270-017-1643-z) contains supplementary material, which is available to authorized users.

Current State of Three-Dimensional Printing for Simulation Training of Interventional Radiology Trainees

“…A recent needs-assessment survey prioritized the development of ultrasound-guided or interventional procedures for simulation-based training [56]. Contrary to aforementioned evidence of existing IR simulators [10,[13][14][15][16][17][18]19], interventional-based simulations remain one of the least common training opportunities available [6]. A survey conducted by Matalon et al found that 40% of radiology residents do not use simulations as part of their procedural training [6].…”

“…This can increase patient anxiety and apprehension, compromise patient safety and satisfaction, and hinder the teaching experience [12,13]. Current simulation options are varied, ranging from video games for inferior vena cava filter placement or percutaneous image-guided interventions [14,15], phantom simulators for Computed Tomography (CT) biopsies [10,[16][17][18], or animal or cadaver models to practice endovascular access or interventions [13,19]. Several studies have used simulators to demonstrate improved procedural technique, either in device manipulation [20][21][22], successful vessel cannulation [23], or reduced procedural time and radiation use [24][25][26].…”

“…Simulations can be categorized by fidelity, or degree of situational realism, anatomic accuracy, or physiologic replication [28]. Although high-fidelity models have been shown to significantly increase technical performance in a simulated environment [29], they are often of higher cost, limited availability, or if using animal or cadaver sources, raise ethical concerns [12,19,28]. The holy grail in simulation medicine is the ability to develop a reproducible, realistic, and inexpensive product, which may be refined via three-dimensional (3D) printing.…”

Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review

“…Simulation with three-dimensional (3D) print models may prove to be a major advantage in congenital cardiac surgery simulation, where trainees are not likely to see all of the extensive variations in the anatomy of congenital heart disease during training ( While cadaveric simulation curriculums have most commonly been incorporated into training in the neurosurgical, general surgical, orthopedic surgical, and trauma surgical specialties, interest in cadaveric simulation for application in teaching basic core surgical skills, common operative procedures, and advanced skills and operative procedures in cardiothoracic surgery as an adjunct to traditional operative training is becoming more prominent (Fig. 2) (Aboud et al, 2011;Inboriboon and Lumlertgul, 2013;Sharma et al, 2013;Massey et al, 2014;Bouma et al, 2015Bouma et al, , 2017Carey et al, 2015;Greene et al, 2015;Mavroudis et al, 2015;Chen et al, 2016;Delpech et al, 2017;Faure et al, 2017;Karras et al, 2017;McLeod et al, 2017;Nesbitt et al, 2018a, b;Sarkar et al, 2018). Cadaveric models provide greater anatomical authenticity, which may be more advantageous for simulation of complex procedures that require greater anatomic accuracy for more advanced learners, full procedural simulations, anatomic dissection, and experience in less familiar surgical exposures (Kuhls et al, 2013).…”

“…In addition to its structural fidelity, modifications to the cadaver model can enhance its physiologic realism, including simulated beating heart, valve motion, circulation, and ventilation ( Fig. 3) (Bouma et al, 2015(Bouma et al, , 2017Carey et al, 2015;Greene et al, 2015;Delpech et al, 2017;Faure et al, 2017;Karras et al, 2017, McLeod et al, 2017. Faure and colleagues created an enhanced cadaveric model that is perfused, pulsatile, and ventilated; a controlled perfusion device is capable of adjusting the flow rate and ventilation frequency via manual adjustment to provide an adaptive response consistent with the simulated clinical situation (Delpech et al, 2017;Faure et al, 2017).…”