EUS-guided angiography: a novel approach to diagnostic and therapeutic interventions in the vascular system

Background: Indications for diagnostic and therapeutic procedures under EUS guidance continue to expand. Objective: To assess the feasibility and safety of EUS-guided angiography in a live porcine model. Setting: Five acute experiments under general anesthesia. Design and Interventions: A linear echoendoscope was advanced into the stomach. Thoracic and abdominal aorta, celiac axis, superior mesenteric and splenic artery, splenic, portal, and hepatic veins were injected with contrast by using FNA needles under fluoroscopy. The animals were then killed for postmortem examination. Main Outcome Measurements: Ability to achieve angiography without complications. Results: All vessels were identified and punctured without technical difficulties. Injections of the large-caliber vessels resulted in a blush of contrast, whereas selective injection of the smaller vessels (splenic artery; hepatic veins) demonstrated clear vascular opacification. Injection of contrast was technically easiest with the 19-gauge FNA needle and most difficult with the 25-gauge needle. There were no changes in vital signs and hemodynamic parameters during vascular injection of any vessel. At necropsy, the 25-gauge FNA needle did not cause any visible vascular injury or bleeding. The 22-gauge needle left a visible puncture mark without active bleeding. in I of 5 pigs, the 19-gauge needle caused a localized vascular hematoma around large-caliber vessels and 150 mL of intra-abdominal blood. Limitation: Technical challenges remain to achieve an adequate flow rate of contrast for prolonged visualization of large vessels. Conclusion: EUS-guided angiography is technically easy and safe and has potential for a wide array of diagnostic and therapeutic vascular interventions.