Endoscopic Ultrasound (EUS)-Guided Angiography: A Novel Approach to Diagnostic and Therapeutic Intravascular Interventions

The ability to visualize and perform therapeutic intervention in the vascular tree makes interventional angiography an invaluable asset in patient care. Current non-surgical vascular interventions are performed via a percutaneous route. Aim: To assess the feasibility of EUS-guided angiography in a porcine model. Methods: This study was approved by the Animal Institutional Review Board. All procedures were performed on 50-kg pigs under general anesthesia with a linear echoendoscope (Olympus® GF-UCT140). The thoracic and abdominal aorta, celiac axis, superior mesenteric artery, splenic vein, portal vein, splenic artery, and hepatic veins were identified. Under the EUS and fluoroscopy guidance intravascular injection of iohexol contrast at a rate of 1 mL/second via 19, 22 and 25 gauge (g) fine-needle aspiration needles was done. Then the animals were eutanized for necropsy. Results: There was excellent EUS visualization of all major abdominal and mediastinal vessels. Selective vessel injections were performed without technical difficulties or acute hemodynamic compromise and demonstrated clear vascular opacification with a blush of the contrast. At necropsy, the 25-g needle did not cause any visible vascular damage or bleeding. The 22-g needle created a visible puncture site on the vessel without any active bleeding. The 19-g needle caused a localized vascular hematoma around large caliber vessels, and 150 mL of intra-abdominal blood. Injection of the contrast was technically easiest with the 19-gauge needle, and the most difficult with the 25-g needle. Conclusions: This is the first study to demonstrate the feasibility and technical challenges of EUS-guided angiography. Vascular injection using a 25-g needle can be performed safely but technical challenges remain to achieve a sufficient flow rate of contrast for adequate visualization of large vessels.