Endovascular and Microsurgical Aneurysm Training in a Chicken Thigh and Leg Pulsatile Model

World Neurosurg. 2019 Apr:124:201-207. doi: 10.1016/j.wneu.2018.12.166. Epub 2019 Jan 11.

Abstract

Background: Neurovascular training models include animal models, synthetics, or computer simulation. In vivo models are expensive and require significant resources. Synthetic/computer models do not reflect the elasticity of fresh vessels. We describe an endovascular and microsurgical training model using a chicken thigh/leg.

Methods: A total of 20 chicken thigh/leg models were obtained. Angiography was used to understand the anatomy. Proximal cannulation with a 5-French catheter was achieved and connected to a hemostatic valve with a pump to simulate pulsatile flow. Aneurysms were created at the thigh-leg junction. For clipping training, 3 types of aneurysms were created to reproduce anatomy seen in middle cerebral, anterior communicating, and posterior communicating aneurysms.

Results: The average cost per specimen was $1.70 ± $0.30. The diameter of the proximal femoral artery was 2.4 mm ± 0.2 mm. The length from the proximal femoral artery to the aneurysm was 9.5 cm ± 0.7 cm. Distal catheterization was successful in all cases (n = 6). Successful deployment of coils and a stent was achieved under fluoroscopic guidance. Gross oversizing of coils and other mistakes led to aneurysm rupture. Each examiner performed an exploration of the pulsatile aneurysm, application and reapplication of a variety of clips, and then the final inspection of branching vessels to confirm patency.

Conclusions: The chicken thigh/leg model provides training opportunities in microsurgical suturing, endovascular techniques for aneurysm obliteration, and microsurgical reconstruction of aneurysms. It combines affordability, time efficiency, and reproducibility. Further studies measuring improvement in technical aneurysm management and comparison with other training models are warranted.

Keywords: Aneurysm; Chicken vascular anatomy; Education; Endovascular treatment; Microsurgical clipping; Microvascular anastomosis; Training.