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논문분류	춘계학술대회 초록집
제목	Swine model for arteriovenous access intervention training and simulation
저자	In Sung Park
출판정보	2023; 2023(1):
키워드
초록	Objectives: Before commencing invasive procedures on hemodialysis patients, simulation utilizing animal models is effective in ensuring safety and reducing complications, especially in nephrologists less familiar with various endovascular devices and angiography suite settings. We created swine arteriovenous (AV) access models and applied training programs for interventional nephrologists. We introduce characteristics of swine AV access models and experiences from the training programs. Methods: Swine are commonly utilized in invasive procedure simulations, given similarities to human vessel anatomy and size. However, there are several considerations in the swine AV access model construction. The brachial artery is typically less than 5mm in diameter and the vasculature of the upper extremity is so tortuous that AV access placement is inappropriate in the upper extremities. In contrast, the superficial femoral artery runs straight and lies adjacent to the femoral vein, hence we placed a looped graft between the superficial femoral artery and vein in the lower extremity of the swine. The blood is typically hypercoagulable, therefore, intravenous heparin and saline are necessary to avoid thrombus formation during access placement. Results: After a looped graft was placed in the lower extremities (Figure 1), trainees performed various endovascular procedures such as percutaneous angioplasty, thrombectomy, and stent placement for the deliberately induced outflow vein stenosis and graft thrombosis in the model. In the upper extremities, trainees practiced precise stent deployments in the central vein (Figure 2). All procedures were conducted under the supervision of experienced interventional nephrologists, and13 nephrologists have undergone the training program through the swine models so far. Conclusions: The swine access model can reproduce clinical conditions such as stenosis, thrombosis, or vessel rupture of AV access, therefore, trainees can practice procedures such as percutaneous transluminal angioplasty, stent placement, and thrombectomy. This model and training program could provide an effective simulation training on endovascular procedures for interventional nephrologists.
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