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Vakhitov D, Chakfé N, Heim F, Chaudhuri A. The Impact of Heli-FX EndoAnchor Application on Endograft Material: An Experimental Study. EJVES Vasc Forum 2024; 62:72-77. [PMID: 39445207 PMCID: PMC11497439 DOI: 10.1016/j.ejvsvf.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/30/2024] [Accepted: 09/04/2024] [Indexed: 10/25/2024] Open
Abstract
Objective The physical impact of the application of Heli-FX EndoAnchors (EA; Medtronic, Minneapolis, USA) on endograft (EG) material is unclear. This study aimed to examine the possible EG membrane alterations after EA implantation. Methods Heli-FX EndoAnchors were applied in vitro into four aortic endocuffs: AFX2 (Endologix Inc., Irvine, USA); Endurant II (Medtronic, Minneapolis, USA); Gore Excluder (W.L. Gore and Assoc., Flagstaff, USA); and Zenith Renu (Cook Aortic Interventions, Bloomington, USA). Two of these, Endurant II and Renu, are made of polyethylene terephthalate (PET), while Excluder and AFX2 are made of expanded polytetrafluoroethylene (ePTFE). The penetration angle was measured for each EA. The EAs were then carefully removed, and perforations examined with digital and fluorescent microscopy. The area and perimeter of the holes were digitally calculated, and material alterations were analysed. Results Of the 13 EAs applied, 12 remained in place. The mean penetration angle was 79°. The ePTFE perforations had oval openings, while PET perforations were round. After EA removal, comparisons between ePTFE and PET material perforations suggested a larger hole area (p = 0.011) and perimeter (p = 0.003) in the former. The ePTFE perforations in the AFX2 were the largest compared with the holes in other endocuffs (p = 0.050). The perforation channel of the ePTFE membrane of the Excluder cuff retained its form after EA removal. Local dissection like layer damage extended further. The perforations in both the Endurant II and the Renu endocuffs shared similar characteristics, with multiple fibres of PET elongated, distorted, or ruptured. Conclusion During EA placement, the EG membrane undergoes local alteration and or destruction. Expanded PTFE, particularly AFX2 endocuffs (for which EA use is not recommended), are characterised by a more extensive degree of material alteration compared with PET. Additional studies are required to chronologically supplement these findings in fatigue tests.
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Affiliation(s)
- Damir Vakhitov
- GEPROMED, Strasbourg, France
- Vascular Centre, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Nabil Chakfé
- GEPROMED, Strasbourg, France
- The Department of Vascular Surgery, Kidney Transplantation and Innovation, Strasbourg University Hospital, Strasbourg, France
| | - Frédéric Heim
- GEPROMED, Strasbourg, France
- Laboratoire de Physique et Mécanique Textile, Université de Haute-Alsace, Mulhouse, France
| | - Arindam Chaudhuri
- GEPROMED, Strasbourg, France
- Bedfordshire - Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
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2
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Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair. Chin Med J (Engl) 2022; 135:2836-2842. [PMID: 36728509 PMCID: PMC9944338 DOI: 10.1097/cm9.0000000000002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA); however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures. METHODS This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed. RESULTS A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5% vs . 80.9%; χ 2 = 4.10; P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06; 95% CI: 1.43-17.95; P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60; 95% CI: 1.17-5.76; P = 0.019), and short neck (OR, 2.85; 95% CI: 1.08-7.52; P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups ( P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair. CONCLUSIONS Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.
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3
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Dalrymple AN, Ting JE, Bose R, Trevathan JK, Nieuwoudt S, Lempka SF, Franke M, Ludwig KA, Shoffstall AJ, Fisher LE, Weber DJ. Stimulation of the dorsal root ganglion using an Injectrode ®. J Neural Eng 2021; 18. [PMID: 34650008 DOI: 10.1088/1741-2552/ac2ffb] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/14/2021] [Indexed: 01/15/2023]
Abstract
Objective. The goal of this work was to compare afferent fiber recruitment by dorsal root ganglion (DRG) stimulation using an injectable polymer electrode (Injectrode®) and a more traditional cylindrical metal electrode.Approach. We exposed the L6 and L7 DRG in four cats via a partial laminectomy or burr hole. We stimulated the DRG using an Injectrode or a stainless steel (SS) electrode using biphasic pulses at three different pulse widths (80, 150, 300μs) and pulse amplitudes spanning the range used for clinical DRG stimulation. We recorded antidromic evoked compound action potentials (ECAPs) in the sciatic, tibial, and common peroneal nerves using nerve cuffs. We calculated the conduction velocity of the ECAPs and determined the charge-thresholds and recruitment rates for ECAPs from Aα, Aβ, and Aδfibers. We also performed electrochemical impedance spectroscopy measurements for both electrode types.Main results. The ECAP thresholds for the Injectrode did not differ from the SS electrode across all primary afferents (Aα, Aβ, Aδ) and pulse widths; charge-thresholds increased with wider pulse widths. Thresholds for generating ECAPs from Aβfibers were 100.0 ± 32.3 nC using the SS electrode, and 90.9 ± 42.9 nC using the Injectrode. The ECAP thresholds from the Injectrode were consistent over several hours of stimulation. The rate of recruitment was similar between the Injectrodes and SS electrode and decreased with wider pulse widths.Significance. The Injectrode can effectively excite primary afferents when used for DRG stimulation within the range of parameters used for clinical DRG stimulation. The Injectrode can be implanted through minimally invasive techniques while achieving similar neural activation to conventional electrodes, making it an excellent candidate for future DRG stimulation and neuroprosthetic applications.
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Affiliation(s)
- Ashley N Dalrymple
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Ave, Wean 1323, Pittsburgh, PA 15217, United States of America.,Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America
| | - Jordyn E Ting
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America
| | - James K Trevathan
- Departments of Biomedical Engineering and Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | | | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | | | - Kip A Ludwig
- Departments of Biomedical Engineering and Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America.,Neuronoff Inc., Cleveland, OH, United States of America.,Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Andrew J Shoffstall
- Neuronoff Inc., Cleveland, OH, United States of America.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Ave, Wean 1323, Pittsburgh, PA 15217, United States of America.,Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America.,Neuroscience Institute, Carnegie Mellon University, 5000 Forbes Ave, Wean 1323, Pittsburgh, PA 15217, United States of America
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4
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Ashraf F, Ambreen T, Park CW, Kim DI. Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis. Clin Hemorheol Microcirc 2021; 78:1-27. [PMID: 33459700 PMCID: PMC8293652 DOI: 10.3233/ch-200996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE: Cross limb stent graft (SG) configuration technique for endovascular aneurysm repair (EVAR) is employed for splayed aortic bifurcations to avoid device kinking and smoothen cannulation. The present study investigates three types of stent graft (SG) configurations for endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm. A computational fluid dynamic analysis was performed on the pulsatile non-Newtonian flow characteristics in three ideally modeled geometries of abdominal aortic (AA) SG configurations. METHODS: The three planar and crosslimb SG configurations were ideally modeled, namely, top-down nonballet-type, top-down ballet-type, and bottom-up nonballet-type configurations. In top-down SG configuration, most of the device is deployed in the main body in the vicinity of renal artery and the limbs are extended to the iliac artery. While in the bottom-up configuration, some of the SG device is deployed in the main body, the limbs are deployed in aortic bifurcation, and the extra stent graft of the main body is extended to the proximal aorta until the below of the renal artery. The effects of non-Newtonian pulsatile flow on the wall stresses and flow patterns of the three models were investigated and compared. Moreover, the average wall shear stress (AWSS), oscillatory shear stress index (OSI), absolute helicity, pressure distribution, graft displacement and flow visualization plots were analyzed. RESULTS: The top-down ballet-type showed less branch blockage effect than the top-down nonballet-type models. Furthermore, the top-down ballet-type configuration showed an increased tendency to sustain high WSS and higher helicity characteristics than that of the bottom-up and top-down non-ballet type configurations. However, displacement forces of the top-down ballet-type configuration were 40% and 9.6% higher than those of the bottom-up and top-down nonballet-type configurations, respectively. CONCLUSIONS: Some complications such as graft tearing, thrombus formation, limb disconnection during long term follow up periods might be relevant to hemodynamic characteristics according to the configurations of EVAR. Hence, the reported data required to be validated with the clinical results.
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Affiliation(s)
- Fahmida Ashraf
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Tehmina Ambreen
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Cheol Woo Park
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
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Wang J, Wang T, Zhao J, Ma Y, Huang B, Yang Y, Yuan D. Effect of limb oversizing on the risk of type Ib endoleak in patients after endovascular aortic repair. J Vasc Surg 2021; 74:1214-1221.e1. [PMID: 33813022 DOI: 10.1016/j.jvs.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We assessed the association between the degree of limb oversizing and the risk of type Ib endoleak (TIBEL) in different types of iliac landing zones after endovascular aortic aneurysm repair. METHODS We performed a retrospective cohort study of patients who had undergone endovascular aortic aneurysm repair with bifurcated and limb endografts in an academic center. The main exposure was the degree of limb oversizing. The primary outcome was the occurrence of TIBELs. The secondary outcomes included limb occlusion, reintervention, and overall survival. Subgroup analyses stratified by ectatic and normal iliac landing zones were performed. Multivariate Cox regression analysis and sensitivity analyses using marginal structure model were conducted to adjust for potential confounders. RESULTS A total of 750 patients with 1500 iliac limb endografts were included in our study (817 limbs with oversizing of ≤10% and 683 with oversizing >10%). The median 1-year freedom from TIBEL was 98.9% (interquartile range [IQR], 98.0%-99.8%) for limbs with oversizing of ≤10% and 99.6% (IQR, 99.0%-100%) for limbs with oversizing >10%. The median 3-year freedom from TIBEL was 95.6% (IQR, 93.1%-98.1%) and 98.2% (IQR, 96.5%-99.9%) for oversizing ≤10% and >10%, respectively. We found that limb oversizing >10% was associated with a significantly decreased risk of TIBEL (adjusted hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.19-0.76) in the overall population. After stratification by ectatic iliac landing zone, we found that limb oversizing >10% was associated with a significantly decreased risk of TIBEL in the ectatic iliac landing zones (adjusted HR, 0.38; 95% CI, 0.16-0.88). However, no significant difference was found in the limb endografts landing in normal iliac arteries (adjusted HR, 0.44; 95% CI, 0.13-1.45). In the subgroup of normal iliac arteries, we observed a significantly increased risk of limb occlusion in the limbs with distal oversizing >15% compared with the limbs with distal oversizing of ≤15% (adjusted HR, 4.66; 95% CI, 1.68-12.91). CONCLUSIONS Adequate limb oversizing >10% was associated with a significantly decreased risk of TIBEL in limbs with ectatic iliac landing zones. However, no additional benefit was observed for oversizing >10% in limb grafts landing in normal iliac arteries. Furthermore, excessive limb oversizing (>15%) in normal iliac landing zones can be associated with an increased risk of limb occlusion.
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Affiliation(s)
- Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Bewley BR, Servais AB, Salehi P. The evolution of stent grafts for endovascular repair of abdominal aortic aneurysms: how design changes affect clinical outcomes. Expert Rev Med Devices 2019; 16:965-980. [DOI: 10.1080/17434440.2019.1684897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Payam Salehi
- Tufts University School of Medicine, Boston, MA, USA
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
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7
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Goudeketting SR, Vermeulen JJM, van Noort K, te Riet o. g. Scholten G, Kuipers H, Slump CH, de Vries JPPM. Effect of Different EndoAnchor Configurations on Aortic Endograft Displacement Resistance: An Experimental Study. J Endovasc Ther 2019; 26:704-713. [DOI: 10.1177/1526602819857586] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Purpose: This study investigated the effect of different EndoAnchor configurations on aortic endograft displacement resistance in an in vitro model. Materials and Methods: An in vitro model was developed and validated to perform displacement force measurements on different EndoAnchor configurations within an endograft and silicone tube. Five EndoAnchor configurations were created: (1) 6 circumferentially deployed EndoAnchors, (2) 5 EndoAnchors within 120° of the circumference and 1 additional, contralateral EndoAnchor, (3) 4 circumferentially deployed EndoAnchors, (4) 2 rows of 4 circumferentially deployed EndoAnchors, and (5) a configuration of 2 columns of 3 EndoAnchors. An experienced vascular surgeon deployed EndoAnchors under C-arm guidance at the proximal sealing zone of the endograft. A constant force with increments of 1 newton (N) was applied to the distal end of the endograft. The force necessary to displace a part of the endograft by 3 mm was defined as the endograft displacement force (EDF). Two video cameras recorded the measurements. Videos were examined to determine the exact moment 3-mm migration had occurred at part of the endograft. Five measurements were performed after each deployed EndoAnchor for each configuration. Measurements are given as the median and interquartile range (IQR) Q1, Q3. Results: Baseline displacement force measurement of the endograft without EndoAnchors resulted in a median EDF of 5.1 N (IQR 4.8, 5.2). The circumferential distribution of 6 EndoAnchors resulted in a median EDF of 53.7 N (IQR 49.0, 59.0), whereas configurations 2 through 5 demonstrated substantially lower EDFs of 29.0 N (IQR 28.5, 30.1), 24.6 N (IQR 21.9, 27.2), 36.7 N, and 9.6 N (IQR 9.4, 10.0), respectively. Decreasing the distance between the EndoAnchors over the circumference of the endograft increased the displacement resistance. Conclusion: This in vitro study demonstrates the influence EndoAnchor configurations have on the displacement resistance of an aortic endograft. Parts of the endograft where no EndoAnchor has been deployed remain sensitive to migration. In the current model, the only configuration that rivaled a hand-sewn anastomosis was the one with 6 EndoAnchors. A circumferential distribution of EndoAnchors with small distances between EndoAnchors should be pursued, if possible. This study provides a quantification of different EndoAnchor configurations that clinicians may have to adopt in clinical practice, which can help them make a measured decision on where to deploy EndoAnchors to ensure good endograft fixation.
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Affiliation(s)
- Seline R. Goudeketting
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Jenske J. M. Vermeulen
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Kim van Noort
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Gerben te Riet o. g. Scholten
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, the Netherlands
| | - Cornelis H. Slump
- MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, the Netherlands
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8
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Torsello GF, Herten M, Müller M, Frank A, Torsello GB, Austermann M. In Vitro Evaluation of the Gore Viabahn Balloon-Expandable Stent-Graft for Fenestrated Endovascular Aortic Repair. J Endovasc Ther 2019; 26:361-368. [DOI: 10.1177/1526602819842569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the safety and integrity of a new stent-graft as a potential bridging device in fenestrated stent-grafts using an in vitro fenestrated model. Materials and Methods: Polyester test sheets with ten 6-mm- or 8-mm-diameter fenestrations were used to simulate a fenestrated main body endoprosthesis. In total, 50 Viabahn balloon-expandable (VBX) stent-grafts of varying lengths (29 and 39 mm) and diameters (6, 7, and 8 mm) were implanted in the fitting fenestrations. After release, the 6- and 7-mm-diameter stent-grafts were flared with a 10×20-mm angioplasty balloon; a 12×20-mm balloon was used in the 8-mm-diameter devices. Safety of the devices was defined as absence of fractures detected on radiography or computed tomography (CT), as well as material failure detected by microscopy and water permeability testing. The forces (in Newtons, N) needed for perpendicular dislocation (pullout force) and axial dislocation (shear stress force) were also evaluated. Results: Forty VBX stent-grafts were subjected to digital radiographic imaging and multiplanar CT. None showed any stent fracture. Subsequent microscopy indicated no damage to the fabric or separation of the graft after flaring. Ten VBX stent-grafts underwent water permeability testing after flaring; no water passed through the graft wall during a 10-minute period under an intraluminal pressure at 120 mm Hg. Testing of 25 VBX stent-grafts revealed initial pullout forces between 11.3 and 31 N. Shear stress tests showed that the average force needed to dislocate the stent-grafts by 50% of their diameter ranged between 5.75 and 6.91 N (mean 6.1±0.5 N) for the 6-mm stents and between 3.31 and 5.4 N (mean 4.4±0.8) for the 8-mm stents. Conclusion: This preliminary study demonstrated the applicability of the VBX as a bridging stent-graft in a simulated fenestration model. A comparison with other stent-grafts and clinical assessment are required.
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Affiliation(s)
- Giovanni Federico Torsello
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Germany
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany
| | - Monika Herten
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany
- Department of Orthopedic and Trauma Surgery, Essen University Hospital, Essen, Germany
| | - Markus Müller
- Biomechanics Laboratory, Department for Hand, Trauma and Reconstructive Surgery, University Hospital Münster, Germany
| | - André- Frank
- Biomechanics Laboratory, Department for Hand, Trauma and Reconstructive Surgery, University Hospital Münster, Germany
| | | | - Martin Austermann
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany
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Karkos CD, Mitka M, Pliatsios I, Giagtzidis IT, Papazoglou KO. Endovascular Management of a Distally Migrated Bifurcated Endograft with a New Bifurcated Endograft. Ann Vasc Surg 2018; 55:309.e9-309.e12. [PMID: 30287290 DOI: 10.1016/j.avsg.2018.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/03/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
A 75-year-old man presented with abdominal and lumbar pain 6 years after previous endovascular repair of an abdominal aortic aneurysm. At the time of the initial operation, the aneurysm measured 6.0 cm in maximum diameter and a bifurcated Anaconda (Vascutek) endograft had been implanted. This time, computed tomography showed a distally migrated endograft which had been folded within the sac and the aneurysm measured 8.4 cm in maximum diameter. We opted to treat this by endovascular means deploying a new bifurcated endograft with suprarenal fixation within the old one. We consider the different management options and discuss the associated technical difficulties.
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Affiliation(s)
- Christos D Karkos
- 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece.
| | - Maria Mitka
- 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Ioannis Pliatsios
- 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Ioakeim T Giagtzidis
- 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Konstantinos O Papazoglou
- 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
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10
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CHIANG CHENGHSIEN, HUNG TINKAN, YEH MINGLONG, CHEN WEILING, KAN CHUNGDANN. FIXATION STUDY OF SINGLE AND DOUBLE STENT GRAFTS FOR ENDOVASCULAR AORTIC REPAIR. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Application of double-barreled cannon stent grafts aortic repair (DoBAR) was reported in 2011 for extremely large aortic aneurysms of patients when there was no proper size of grafts for the emergent treatment. Fixation characteristics of the double stent grafts are obtained in a laboratory setting, and are incorporated with those of single Zenith TX2 grafts of sizes from 34 to 42[Formula: see text]mm. Radial stress and shear increase linearly with the oversizing parameter but decrease with increasing stent diameter. The slope of the linear relationship is practically the same for this group of grafts. When the original circular stent grafts of diameter 36 and 38[Formula: see text]mm are deformed to form DoBAR of diameter 44 or 46.4[Formula: see text]mm, the formation could provide higher radial stress and shear to secure fixation for endo-aortic repair. The experimental results of single and DoBAR grafts can be incorporated for clinical application of DoBAR for emergent treatment.
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Affiliation(s)
- CHENG-HSIEN CHIANG
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, Daxue Road, East District, Tainan City 701, Taiwan
| | - TIN-KAN HUNG
- Department of Bioengineering, University of Pittsburgh, 700 O’Hara Street, Pittsburgh, PA 15261, USA
| | - MING-LONG YEH
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, Daxue Road, East District, Tainan City 701, Taiwan
| | - WEI-LING CHEN
- Department of Engineering and Maintenance, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City 81362, Taiwan
| | - CHUNG-DANN KAN
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng-Li Road, Tainan 704, Taiwan
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11
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Schoretsanitis N, Georgakarakos E, Argyriou C, Ktenidis K, Georgiadis GS. A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms. Radiol Med 2017; 122:309-318. [DOI: 10.1007/s11547-017-0724-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
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12
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Stefanov F, McGloughlin T, Morris L. A computational assessment of the hemodynamic effects of crossed and non-crossed bifurcated stent-graft devices for the treatment of abdominal aortic aneurysms. Med Eng Phys 2016; 38:1458-1473. [PMID: 27773830 DOI: 10.1016/j.medengphy.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 08/22/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
There are several issues attributed with abdominal aortic aneurysm endovascular repair. The positioning of bifurcated stent-grafts (SG) may affect SG hemodynamics. The hemodynamics and geometrical parameters of crossing or non-crossing graft limbs have not being totally accessed. Eight patient-specific SG devices and four pre-operative cases were computationally simulated, assessing the hemodynamic and geometrical effects for crossed (n= 4) and non-crossed (n= 4) configurations. SGs eliminated the occurrence of significant recirculations within the sac prior treatment. Dean's number predicted secondary flow locations with the greatest recirculations occurring at the outlets especially during the deceleration phase. Peak drag force varied from 3.9 to 8.7N, with greatest contribution occurring along the axial and anterior/posterior directions. Average resultant drag force was 20% smaller for the crossed configurations. Maximum drag force orientation varied from 1.4° to 51°. Drag force angle varied from 1° to 5° during one cardiac cycle. 44% to 62% of the resultant force acted along the proximal centerline where SG migration is most likely to occur. The clinician's decision for SG positioning may be a critical parameter, and should be considered prior to surgery. All crossed SG devices had an increased spiral flow effect along the distal legs with reductions in drag forces.
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Affiliation(s)
- Florian Stefanov
- Galway Medical Technologies Centre, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland
| | - Tim McGloughlin
- Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Liam Morris
- Galway Medical Technologies Centre, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland.
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An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents. MATERIALS 2016; 9:ma9020113. [PMID: 28787913 PMCID: PMC5456472 DOI: 10.3390/ma9020113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.
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Swaelens C, Poole RJ, Torella F, McWilliams RG, England A, Fisher RK. Type IIIb Endoleak and Relining. J Endovasc Ther 2016; 23:297-301. [DOI: 10.1177/1526602816631106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To examine the changes in distraction force following relining of a conventional abdominal aortic stent-graft with a type IIIb endoleak using the Nellix endovascular sealing device compared to a unilateral stent-graft. Methods: Relining is often used to repair type IIIb endoleaks, but the consequences to graft stability are unknown. A mathematical model was constructed based on pressure and volume flow through the stent-grafts, incorporating recognized distraction force equations. Steady flow was presumed at peak systolic pressures to calculate the maximum distraction force, with gravity ignored. Distraction forces for 28- to 36-mm-diameter stent-graft bodies with 16-mm limbs were calculated and compared to forces following relining with single and double Nellix devices or the Renu unilateral device. Results: Distraction forces for the 28-, 32-, and 36-mm stent-grafts prior to relining were 5.99, 10.21, and 14.99 N, respectively. Similar forces were reported after relining with bilateral Nellix devices (5.86, 10.08, and 14.86 N, respectively). However, use of a unilateral Nellix increased the distraction forces to 9.92, 14.14, and 18.92 N, respectively. These were comparable to the increase observed after relining with a Renu unilateral stent-graft (9.87, 14.09, and 18.86 N, respectively). The proportional increase in distraction force for a unilateral relining ranged from 26% to 66%, with the greatest increase noted in the smaller diameter main bodies. Conclusion: Relining a stent-graft with a type IIIb endoleak using bilateral Nellix devices does not increase the distraction force. However, a unilateral Nellix device or the Renu system could theoretically increase the distraction force by up to 66%, potentially risking migration and type Ia endoleak. In clinical practice, these results suggest that a relining with bilateral Nellix may have benefits over the Renu unilateral stent-graft.
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Affiliation(s)
- Charles Swaelens
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Francesco Torella
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Richard G. McWilliams
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Robert K. Fisher
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
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15
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Rahmani S, Grewal IS, Nabovati A, Doyle MG, Roche-Nagle G, Tse LW. Increasing angulation decreases measured aortic stent graft pullout forces. J Vasc Surg 2016; 63:493-9. [DOI: 10.1016/j.jvs.2014.06.115] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/14/2014] [Indexed: 11/17/2022]
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16
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Chiang CH, Yeh ML, Chen WL, Kan CD. Apparatus for Comparison of Pullout Forces for Various Thoracic Stent Grafts at Varying Neck Angulations and Oversizes. Ann Vasc Surg 2015; 31:196-204. [PMID: 26597245 DOI: 10.1016/j.avsg.2015.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/07/2015] [Accepted: 10/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to provide an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. METHODS An in vitro platform capable of performing pullout tests was used on stent grafts in angulated silicone tubes designed for this study (0°, 45°, 90°, and 135° with a 32-mm inner diameter) in a temperature-controlled chamber (37 ± 2°C). Three commercial stent grafts with sizes commonly used in Taiwan (Valiant: 34, 36, 38, and 40 mm; Zenith TX2: 34, 36, 38, and 40 mm; and TAG: 34, 37, and 40 mm) were used, and each size was tested 8 times for each angulation condition. RESULTS The mean dislodgement forces (DFs) at 0° angulation within 10-20% oversize were approximately 22.7, 9.6, and 9.0 N for the Valiant, Zenith TX2, and TAG devices, respectively, whereas the mean DFs decreased by 46%, 38%, and 50% to 12.3, 5.9, and 4.5 N when the angulation reached 135°. Regression analysis shows that neck angulation was a significant factor for the Valiant and Zenith TX2 devices (P < 0.0001 and P < 0.0001, respectively) but not for the TAG device (P = 0.483). In addition, oversize and interactions between variables (angulation × oversize) exhibited significant effects on the DFs for all devices (P < 0.0001). CONCLUSIONS We successfully built up an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. With the empirical comparative data of different brand stent grafts under various conditions shown and compared, our findings suggest that aortic neck angulation has a negative correlation with stent-graft fixation. To have better stent-graft fixation and seal in the aortic arch for thoracic endovascular aortic repair, a longer landing zone with cautiously selected oversize is a more suitable selection.
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Affiliation(s)
- Cheng-Hsien Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ling Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Dann Kan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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17
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Karkos CD, Kapetanios DM, Anastasiadis PT, Grigoropoulou FS, Kalogirou TE, Giagtzidis IT, Papazoglou KO. Endovascular Repair of Abdominal Aortic Aneurysms with the Anaconda™ Stent Graft: Mid-term Results from a Single Center. Cardiovasc Intervent Radiol 2015; 38:1416-24. [DOI: 10.1007/s00270-015-1081-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/08/2015] [Indexed: 11/24/2022]
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18
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Georgakarakos E, Gasser TC, Xenos M, Kontopodis N, Georgiadis GS, Ioannou CV. Applying findings of computational studies in vascular clinical practice: fact, fiction, or misunderstanding? J Endovasc Ther 2015; 21:434-8. [PMID: 24915594 DOI: 10.1583/14-4718e.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
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19
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Altnji HE, Bou-Saïd B, Walter-Le Berre H. Morphological and stent design risk factors to prevent migration phenomena for a thoracic aneurysm: A numerical analysis. Med Eng Phys 2015; 37:23-33. [DOI: 10.1016/j.medengphy.2014.09.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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20
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Freyrie A, Gallitto E, Gargiulo M, Faggioli G, Massoni CB, Mascoli C, Pini R, Stella A. Results of the endovascular abdominal aortic aneurysm repair using the Anaconda aortic endograft. J Vasc Surg 2014; 60:1132-1139. [PMID: 25441690 DOI: 10.1016/j.jvs.2014.04.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate early and late results of the Anaconda aortic endograft (Vascutek, Terumo, Inchinnan, Scotland) in a single-center experience. METHODS From September 2005 to March 2012, patients underwent endovascular aortic repair for abdominal aortic aneurysm (AAA) with Anaconda endograft were prospectively enrolled in a dedicated database. Demographic and aortoiliac morphological data were considered. Preoperative planning was based on thoracoabdominal and pelvic computed tomography angiography. Follow-up included duplex ultrasound or computed tomography angiography at 1, 6, and 12 months and yearly thereafter. Primary end points were technical success, early and late primary and primary assisted clinical success (CS), overall and AAA-related survival and freedom from reinterventions. Secondary end points were endoleaks (ELs), steno-obstructive iliac leg complications, and AAA shrinkage. RESULTS An Anaconda endograft was implanted in 177 patients (male 94%; mean age, 73.3 ± 7.4 years; American Society of Anesthesiologists class III-IV, 85% and 9%, respectively). The mean AAA diameter, neck length, and diameter were 55 ± 9.7 mm, 26.7 ± 10 mm, and 23 ± 2.3 mm, respectively. There was an aortic neck angle >60° in 44 (25%) patients. Iliac angles >90° were observed in 152 (43%) iliac axes. Technical success was 98.9%. Early CS was 96%. Mean follow-up was 33 ± 23.3 months. Late assisted CS was 97.7%. Survival at 12, 24, and 36 months was 96.4%, 89%, and 86.2%, respectively. There was only one case of late AAA-related mortality. Freedom from reintervention was 94%, 92%, and 85% at 12, 24, and 36 months, respectively. Three (1.7%) conversions occurred during follow-up. There were 14.1% ELs at the completion angiography (EL Ia, 1.1%; EL II, 13%). Late ELs were 20.2% (EL Ia, 1.1%; EL Ib, 2.2%; EL II, 16.9%). Iliac leg complications occurred in 5.6% of the cases. An AAA shrinkage >5 mm was observed in 130 (73.4%) patients. In 7 (4%) cases there was an AAA enlargement >5 mm. CONCLUSIONS Data in our series demonstrate that the Anaconda endograft has good early and late results in the treatment of AAAs.
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MESH Headings
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/mortality
- Aortic Aneurysm, Abdominal/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/mortality
- Constriction, Pathologic
- Databases, Factual
- Disease-Free Survival
- Endoleak/etiology
- Endoleak/surgery
- Endovascular Procedures/adverse effects
- Endovascular Procedures/instrumentation
- Endovascular Procedures/mortality
- Female
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/surgery
- Humans
- Italy
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Prosthesis Design
- Reoperation
- Stents
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography, Doppler, Duplex
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Affiliation(s)
| | | | | | | | | | | | - Rodolfo Pini
- Vascular Surgery, University of Bologna, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, University of Bologna, Bologna, Italy
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21
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Georgakarakos E, Argyriou C, Schoretsanitis N, Ioannou CV, Kontopodis N, Morgan R, Tsetis D. Geometrical Factors Influencing the Hemodynamic Behavior of the AAA Stent Grafts: Essentials for the Clinician. Cardiovasc Intervent Radiol 2014; 37:1420-9. [DOI: 10.1007/s00270-014-0927-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/27/2014] [Indexed: 11/29/2022]
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22
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de Beaufort H, Zandvoort HJ, Moll FL, Van Herwaarden JA. The Endurant stent graft for endovascular aneurysm repair. Expert Rev Med Devices 2014; 11:331-40. [DOI: 10.1586/17434440.2014.916206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Rödel SG, Zeebregts CJ, Huisman AB, Geelkerken RH. Results of the Anaconda endovascular graft in abdominal aortic aneurysm with a severe angulated infrarenal neck. J Vasc Surg 2014; 59:1495-501, 1501.e1. [DOI: 10.1016/j.jvs.2013.12.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
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24
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Shek TLT, Tse LW, Nabovati A, Amon CH. Computational fluid dynamics evaluation of the cross-limb stent graft configuration for endovascular aneurysm repair. J Biomech Eng 2014; 134:121002. [PMID: 23363204 DOI: 10.1115/1.4007950] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The technique of crossing the limbs of bifurcated modular stent grafts for endovascular aneurysm repair (EVAR) is often employed in the face of splayed aortic bifurcations to facilitate cannulation and prevent device kinking. However, little has been reported about the implications of cross-limb EVAR, especially in comparison to conventional EVAR. Previous computational fluid dynamics studies of conventional EVAR grafts have mostly utilized simplified planar stent graft geometries. We herein examined the differences between conventional and cross-limb EVAR by comparing their hemodynamic flow fields (i.e., in the "direct" and "cross" configurations, respectively). We also added a "planar" configuration, which is commonly found in the literature, to identify how well this configuration compares to out-of-plane stent graft configurations from a hemodynamic perspective. A representative patient's cross-limb stent graft geometry was segmented using computed tomography imaging in Mimics software. The cross-limb graft geometry was used to build its direct and planar counterparts in SolidWorks. Physiologic velocity and mass flow boundary conditions and blood properties were implemented for steady-state and pulsatile transient simulations in ANSYS CFX. Displacement forces, wall shear stress (WSS), and oscillatory shear index (OSI) were all comparable between the direct and cross configurations, whereas the planar geometry yielded very different predictions of hemodynamics compared to the out-of-plane stent graft configurations, particularly for displacement forces. This single-patient study suggests that the short-term hemodynamics involved in crossing the limbs is as safe as conventional EVAR. Higher helicity and improved WSS distribution of the cross-limb configuration suggest improved flow-related thrombosis resistance in the short term. However, there may be long-term fatigue implications to stent graft use in the cross configuration when compared to the direct configuration.
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Affiliation(s)
- Tina L T Shek
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G8, Canada
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25
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Experience with a novel custom-made fenestrated stent graft in the repair of juxtarenal and type IV thoracoabdominal aneurysms. J Vasc Surg 2014; 59:615-22. [DOI: 10.1016/j.jvs.2013.10.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/19/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022]
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26
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von Sachsen S, Senf B, Burgert O, Meixensberger J, Florek HJ, Mohr FW, Etz CD. Stent graft visualization and planning tool for endovascular surgery using finite element analysis. Int J Comput Assist Radiol Surg 2013; 9:617-33. [PMID: 24170574 DOI: 10.1007/s11548-013-0943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 09/03/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE A new approach to optimize stent graft selection for endovascular aortic repair is the use of finite element analysis. Once the finite element model is created and solved, a software module is needed to view the simulation results in the clinical work environment. A new tool for interpretation of simulation results, named Medical Postprocessor, that enables comparison of different stent graft configurations and products was designed, implemented and tested. METHODS Aortic endovascular stent graft ring forces and sealing states in the vessel landing zone of three different configurations were provided in a surgical planning software using the Medical Imaging Interaction Tool Kit (MITK) software system. For data interpretation, software modules for 2D and 3D presentations were implemented. Ten surgeons evaluated the software features of the Medical Postprocessor. These surgeons performed usability tests and answered questionnaires based on their experience with the system. RESULTS The Medical Postprocessor visualization system enabled vascular surgeons to determine the configuration with the highest overall fixation force in 16+/-6 s, best proximal sealing in 56+/-24s and highest proximal fixation force in 38+/- s. The majority considered the multiformat data provided helpful and found the Medical Postprocessor to be an efficient decision support system for stent graft selection. The evaluation of the user interface results in an ISONORM-conform user interface (113.5 points). CONCLUSION The Medical Postprocessor visualization software tool for analyzing stent graft properties was evaluated by vascular surgeons. The results show that the software can assist the interpretation of simulation results to optimize stent graft configuration and sizing.
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Affiliation(s)
- S von Sachsen
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany,
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27
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Stather PW, Wild JB, Sayers RD, Bown MJ, Choke E. Endovascular Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy. J Endovasc Ther 2013; 20:623-37. [DOI: 10.1583/13-4320mr.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Stefanov F, McGloughlin T, Delassus P, Morris L. Hemodynamic variations due to spiral blood flow through four patient-specific bifurcated stent graft configurations for the treatment of abdominal aortic aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2013; 29:179-196. [PMID: 23255342 DOI: 10.1002/cnm.2525] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 09/18/2012] [Accepted: 10/07/2012] [Indexed: 06/01/2023]
Abstract
Endovascular repair is now a recognised procedure for treating abdominal aortic aneurysms. However, post-operative complications such as stent graft migration and thrombus may still occur. To assess these complications numerically, the correct input boundary conditions, which include the full human aorta with associated branching, should be included. Four patient-specific computed tomography scanned bifurcated stent grafts (SGs) were modelled and attached onto a full human aorta, which included the ascending, aortic arch and descending aortas. Two of the SG geometries had a twisted leg configuration, while the other two had conventional nontwisted leg configurations. Computational fluid dynamics was completed for both geometries and the hemodynamics assessed. The complexity of the flow patterns and secondary flows were influenced by the inclusion of the full human aorta at the SG proximal section. During the decelerating phase significant recirculations occurred along the main body of all SG configurations. The inclusion of the full human aorta did not impact the velocity contours within the distal legs and there was no difference in drag forces with the SG containing the full human aorta and those without. A twisted leg configuration further promoted a spiral flow formation along its distal legs.
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Affiliation(s)
- Florian Stefanov
- Galway Medical Technologies Centre-GMedTech, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland
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29
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Melas N, Perdikides T, Saratzis A, Saratzis N, Kiskinis D, Deaton DH. Helical EndoStaples enhance endograft fixation in an experimental model using human cadaveric aortas. J Vasc Surg 2012; 55:1726-33. [DOI: 10.1016/j.jvs.2011.11.048] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/02/2011] [Accepted: 11/05/2011] [Indexed: 11/27/2022]
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30
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Kvinlaug KE, Lawlor DK, Forbes TL, Willoughby R, MacKenzie KS, DeRose G, Corriveau MM, Steinmetz OK. Early Results From a Canadian Multicenter Prospective Registry of the Endurant Stent Graft for Endovascular Treatment of Abdominal Aortic Aneurysms. J Endovasc Ther 2012; 19:58-66. [DOI: 10.1583/11-3622.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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31
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Melas N, Saratzis A, Dixon H, Saratzis N, Lazaridis J, Perdikides T, Kiskinis D. Isolated Common Iliac Artery Aneurysms:A Revised Classification to Assist Endovascular Repair. J Endovasc Ther 2011; 18:697-715. [PMID: 21992642 DOI: 10.1583/11-3519.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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32
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Melas N, Saratzis A, Saratzis N, Lazaridis J, Psaroulis D, Trygonis K, Kiskinis D. Aortic and Iliac Fixation of Seven Endografts for Abdominal-aortic Aneurysm Repair in an Experimental Model Using Human Cadaveric Aortas. Eur J Vasc Endovasc Surg 2010; 40:429-35. [DOI: 10.1016/j.ejvs.2010.07.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/03/2010] [Indexed: 10/19/2022]
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33
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Scherer S, Treichel T, Ritter N, Triebel G, Drossel WG, Burgert O. Surgical stent planning: simulation parameter study for models based on DICOM standards. Int J Comput Assist Radiol Surg 2010; 6:319-27. [DOI: 10.1007/s11548-010-0511-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 06/19/2010] [Indexed: 11/28/2022]
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34
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The effect of injectable biocompatible elastomer (PDMS) on the strength of the proximal fixation of endovascular aneurysm repair grafts: An in vitro study. J Vasc Surg 2010; 52:152-8. [DOI: 10.1016/j.jvs.2010.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/28/2009] [Accepted: 01/03/2010] [Indexed: 11/17/2022]
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