Feasibility of Placenta as an Ex Vivo Training Model for Simulation of Endovascular Intervention

• Review preparation and set up of placenta as an endovascular training mode


• Pictorial review of the procedures and techniques performed


• Provide general practical tips for optimal simulation practice

The human placenta has been studied as an ex vivo training model, predominantly within the neuro-endovascular realm. Limited evidence exists, but its feasibility as a training model has been demonstrated for simulation of stent assisted coiling, thrombolysis and thrombectomy. In contrast, there has been little research in using placenta as a training model for endovascular body IR procedures. The purpose of this exhibit is to provide a review of the preparation and set up protocol of the placenta model and provide a pictorial review of the procedures successfully performed with practical tips on optimizing simulation of endovascular intervention.

Clinical Findings/Procedure Details:

Preparation: Healthy placentas delivered at 37+ weeks gestational age were obtained from the obstetrics unit with a short segment of cord attached and stored in the fridge for several days (up to 1 week). Arteries and vein were cannulated with 6-8 Fr 10 cm sheaths. Super glue was used to secure sheaths as necessary and prevent backflow. 

Set-up: Placenta placed on 3D printed plastic stand on fluoroscopy table. Tilted top allows gravitational fluid flow to small hole attached via tubing to a foley drainage bag. Normal saline flush solution (mixed with albumin as necessary) was infused with pressure infuser at 150 mmHg and attached to sheath to simulate flow. 

Successfully Simulated Scenarios: Angiography. Simulated active extravasation and aneurysm with embolization. Coil and liquid embolization including pressure cooker technique. Thrombus deployment and mechanical thrombectomy. Stent and flow diverter deployment and retrieval. Each procedure will be reviewed with fluoroscopic images and direct visualization images of the placenta with practical tips for optimizing simulation.

Sample Practical Tips: Emulating saccular aneurysm by tightening a suture around a branch vessel creating a proximal occlusion. Adjusting tortuosity by inserting suture along an existing curvature, attaching string to a hemostat, and positioning or applying tension as necessary to adjust bends.

Conclusion and/or Teaching Points:

The placenta is a feasible, cost-effective, practical model for endovascular simulation in IR with realism that exceeds that of more traditional simulation models. This pictorial review can serve as a practical guide for implementing this model for procedural training at other institutions.