Thoracic Surgery
CVI hybrid surgery combines endovascular and open surgical techniques in a hybrid operating room for complex cardiovascular interventions. CSTs manage both catheter-based delivery systems and traditional vascular instruments simultaneously, supporting procedures like EVAR, TEVAR, and fenestrated endografts. Cases require dual sterile field management, fluoroscopy coordination, and seamless transitions between endovascular and open surgical phases.
Role of CSTs
- Prepare hybrid OR with C-arm fluoroscopy, fixed imaging systems, and dual sterile fields
- Manage endovascular delivery systems, guidewires, and catheter sheaths
- Support open surgical access with vascular clamps and anastomosis instruments
- Coordinate sterile transitions between endovascular and open surgical phases
- Handle stent grafts, fenestrations, and branch vessel stent deployment
- Maintain fluoroscopy sterile draping and imaging equipment positioning
- Assist with vascular closure devices and hemostasis management
Essential Skills
- Proficiency with endovascular delivery systems and guidewire management
- Knowledge of fluoroscopy sterile technique and C-arm positioning
- Understanding of hybrid OR sterile field transitions
- Safe handling of stent grafts and fenestrated endografts
- Coordination between endovascular and vascular surgical teams
- Familiarity with vascular closure devices and access site management
- Management of contrast media and anticoagulation protocols
Common Procedures
- Endovascular aneurysm repair (EVAR)
- Thoracic endovascular aortic repair (TEVAR)
- Fenestrated endograft placement
- Branched endograft procedures
- Iliac branch device implantation
- Visceral artery stent grafting
- Hybrid arch debranching and TEVAR
- Aorto-uni-iliac (AUI) with fem-fem crossover
Instruments & Equipment
Instruments
- Vascular clamps (Satinsky, Fogarty, partial occlusion)
- Endovascular instrument tray (sheath introducers, dilators)
- Heavy suture materials for open access
- Vascular anastomosis instruments
- Tying platforms and vessel loops
- Skin hooks and DeBakey forceps
- Argon beam coagulator
Equipment
- Fixed C-arm fluoroscopy system
- Portable C-arm backup imaging
- Endovascular table with radiolucent capabilities
- Contrast media injectors and power injection systems
- Hemodynamic monitoring equipment
- Vascular closure device deployment systems
- Stent graft delivery systems
- IVUS and angiography catheters
Workflow & Case Progress
- Prepare dual sterile fields for endovascular and open surgical phases
- Set up fluoroscopy systems and confirm imaging positioning
- Support percutaneous access with guidewires, sheaths, and dilators
- Assist with stent graft deployment and positioning under fluoroscopy
- Manage open surgical exposure for branch vessel preservation
- Coordinate vascular reconstruction and anastomosis procedures
- Support access site closure with vascular closure devices
- Confirm final positioning with angiography and complete hemostasis
Sterile Technique Considerations
- Dual sterile fields require clear physical separation and color-coded drapes
- Fluoroscopy equipment creates high contamination risk during positioning
- Endovascular instruments must remain within dedicated sterile zones
- Stent graft packaging demands glove change before sterile field introduction
- Multiple access sites require organized sheath and catheter management
- Contrast media spills increase slippery surface contamination risk
Career Pathways
- Cross-training in Endovascular Surgery and Vascular Surgery
- Certification in hybrid OR technology and fluoroscopy safety
- Specialization in complex aortic endograft procedures
- Leadership roles in hybrid operating room coordination
- Education roles in endovascular surgical technology
- Research involvement in next-generation endograft technologies
How to Prepare
- Study endovascular access techniques and sheath management
- Practice fluoroscopy sterile draping and C-arm positioning
- Learn stent graft deployment systems and sizing protocols
- Review hybrid OR sterile field transition workflows
- Familiarize with vascular closure devices and hemostasis techniques
- Build knowledge of contrast media management and radiation safety