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Christoforou P, Kounnos C, Kapoulas K, Bekos C. Combined AFX2 with thoracic stent graft: A different endovascular approach of an abdominal aorta aneurysm. SAGE Open Med Case Rep 2023; 11:2050313X231189769. [PMID: 37529078 PMCID: PMC10388611 DOI: 10.1177/2050313x231189769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/07/2023] [Indexed: 08/03/2023] Open
Abstract
The AFX2 endovascular repair system is a unibody, bifurcated stent graft that can be used in an abdominal aortic aneurysm associated with anatomical challenges, especially if it is combined with different aortic cuffs. The use of an AFX2 main body combined with a thoracic stent graft as a proximal aortic cuff was selected to treat a 77-year-old male patient with abdominal aortic aneurysm. The AFX2 endograft combined with a proximal thoracic aortic cuff plays a safe and effective role in treating complex infrarenal abdominal aortic aneurysm that may otherwise be technically more challenging with the open technique and inaccessible with the traditional endovascular technique.
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Affiliation(s)
- Panagitsa Christoforou
- Panagitsa Christoforou, Nicosia General Hospital, 215, Paleos Dromos Lefkosia-Lemesos Street, Strovolos, Nicosia 2029, Cyprus.
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Torsello G, Müller M, Litterscheid S, Berekoven B, Austermann M, Torsello GF. Fatigue Resistance of the Advanta V12/iCast and Viabahn Balloon-Expandable Stent-Graft as Bridging Stents in Experimental Fenestrated Endografting. J Endovasc Ther 2021; 28:463-468. [PMID: 33629597 DOI: 10.1177/1526602821996724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Bridging stents undergo millions of cycles during respiratory movements of the kidneys throughout the patient's life. Thus, understanding the response of fabric and endoskeleton of the stent to cyclic loading over the time is crucial. In this study, we compare the fatigue resistance of the Viabahn Balloon-Expandable stent-graft (VBX) with the widely used Advanta V12/iCast under prolonged stress induction. MATERIALS AND METHODS A polyester test sheet with 10 fenestrations was used simulating a fenestrated endograft. Five 6×59 mm VBX stent-grafts and five 6×58 mm Advanta stent-grafts were implanted into 6×6 mm fenestrations. The stents were flared with a 10×20 mm PTA (percutaneous transluminal angioplasty) catheter and connected with a fatigue stress machine. All stent-grafts were evaluated by microscopy and radiography at baseline and after regular intervals until 50,000,000 cycles were applied, simulating a life span of approximately 75 months. Freedom from fracture (FF), freedom from initial polytertafluoroethylene (PTFE) changes (FIC), and from PTFE breakpoint (FBP, all-layer defect) were calculated. RESULTS Digital radiographic images did not show any stent fracture in both groups after 50,000,000 cycles. The VBX stent-graft was free from any all-layer defects at the conclusion of 50,000,00 cycles resulting in a significant higher FBP compared with Advanta V12 (50,000,000 vs 33,400,000; p<0.01). All-layer defects were observed only in the Advanta group. Two of 5 Advanta stents showed early penetration of the nitinol ring causing a defect of PTFE. Regarding FIC, there was no significant difference between the stents (3,400,000 in VBX vs 3,200,000 in Advanta). CONCLUSIONS In fatigue tests simulating respiration movements, VBX and Advanta V12 performed equally well in terms of fracture resistance and freedom from initial PTFE changes. VBX maintained freedom from PTFE breakpoint throughout the full 50,000,000 cycles. All-layers defects were detected only in Advanta and were mainly caused by penetration of the nitinol ring through the PTFE.
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Affiliation(s)
- Giovanni Torsello
- Institute for Vascular Research, St Franziskus Hospital, Münster, Germany
| | - Marcus Müller
- Biomechanics Laboratory, Department for Hand, Trauma and Reconstructive Surgery, University Hospital, Münster, Germany
| | - Sarah Litterscheid
- Institute for Vascular Research, St Franziskus Hospital, Münster, Germany
| | - Bärbel Berekoven
- Department of Vascular Surgery, St Franziskus Hospital, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St Franziskus Hospital, Münster, Germany
| | - Giovanni-Federico Torsello
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine, Berlin, Germany
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Raison-Peyron N, Du-Thanh A, Compan C, Perrochia H, Francini S, Duflos C, Crochet P. Are Adverse Events Attributed to Essure Associated With Nickel Sensitization? Dermatitis 2020; 31:122-7. [PMID: 32168143 DOI: 10.1097/DER.0000000000000489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Essure is an effective method for hysteroscopic sterilization. Reports of adverse effects, the underlying mechanisms of which are unknown, have increased in recent years. OBJECTIVE The aim of the study was to determine whether there is a relationship between adverse events attributed to Essure and nickel sensitization. METHODS Patients presenting alleged adverse reactions to Essure were referred for nickel patch testing before removal. Data regarding medical history of nickel sensitization and symptoms attributed to Essure were collected. Dimethylglyoxime spot tests were performed on the explanted Essure. There was a follow-up at 3 months to evaluate whether there is improvement of the symptoms after Essure removal. CONCLUSIONS Nickel sensitization via the classic delayed hypersensitivity pathway did not seem to be responsible for adverse events attributed to Essure. Among systemic symptoms reported, extracutaneous symptoms had the highest prevalence. Systemic contact dermatitis to nickel could not be ruled out in one case.
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Pandelea-dobrovicescu G, Prodana M, Golgovici F, Ionita D, Sajin M, Demetrescu I. Surface Morphology and Histopathological Aspects of Metallic Used Cardiovascular CoCr Stents. Metals 2020; 10:1112. [DOI: 10.3390/met10091112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, CoCr cardiovascular metallic stents with the same chemical composition as well as the adjacent tissues were analyzed. Recovered stents and adjacent tissues were characterized by surface morphology techniques like light microscopy (LM), scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDS) and transmission electron microscopy (TEM). The presence of metals in the tissue from around explanted stent was also confirmed by TEM method. The released metal ions were measured using inductively coupled plasma mass spectrometry (ICP-MS). Histopathological analysis was used to highlight host tissue response to the implanted stents. EDX analysis revealed that 21 stents had the same composition. The quantities of Cr ions detected in the tissues were between 5 and 14 ppb and for Co ions were between 4 and 10 ppb. The tissue sections near the layers that generated large quantities of ions showed restenosis development and the deposits of surface calcifications were highlighted. The heavy metal levels observed in this study due to corrosion are too low to cause a systemic toxic response.
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Sun F, Jordan L, Albin V, Lair V, Ringuedé A, Prima F. On the High Sensitivity of Corrosion Resistance of NiTi Stents with Respect to Inclusions: An Experimental Evidence. ACS Omega 2020; 5:3073-3079. [PMID: 32095730 PMCID: PMC7033967 DOI: 10.1021/acsomega.9b04312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/28/2020] [Indexed: 06/02/2023]
Abstract
In this study, the electrochemical breakdown potentials (E b) of NiTi stents were assessed in correlation to their nonmetallic inclusion fractions in the extra low inclusion (ELI) range (inclu.% < 1% in area fraction, average size <39 μm). Quantitative investigations were performed to study the role of nonmetallic inclusions during pitting corrosion. Two stent samples with different inclusion fractions were fabricated using commercial NiTi tubes for studying the corrosion and mechanism. A survey of seven commercial stents in Europe was also conducted. Dependence was observed between the breakdown potentials and the inclusion fractions in the ELI stent (inclu.% = 0.2-0.8%), in which the breakdown potentials were found to be inversely proportional to inclusion fractions and densities (E b dropped from ∼800 to ∼400 mV). No breakdown occurred on the samples using high-purity NiTi materials (inclu.% < 0.1%). The roles of inclusions in pitting mechanisms were investigated using scanning electron microscopy (SEM) characterizations. The microstructural evidence showed that the impact of TiC and Ti2NiO x was very different in the pitting process. A maximum inclu.% ≤ 0.9% was required for obtaining E b ≥ 600 mV to meet the Food and Drug Administrations (FDA's) in vivo safety acceptance (low risk up to 6 months postimplantation). The high-purity stents (inclu.% < 0.1%) did not exhibit corrosion susceptibility until 1000 mV, suggesting superior corrosion resistance and thus long-term in vivo safety.
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Affiliation(s)
- Fan Sun
- Chimie
ParisTech, PSL University, CNRS, Institut
de Recherche de Chimie Paris, 75005 Paris, France
| | - Laurence Jordan
- Chimie
ParisTech, PSL University, CNRS, Institut
de Recherche de Chimie Paris, 75005 Paris, France
- University
Paris Diderot, Sorbonne Paris Cité, Paris F-75013, France
- AP-HP,
Hospital Rothschild, Paris F-75012, France
| | - Valérie Albin
- Chimie
ParisTech, PSL University, CNRS, Institut
de Recherche de Chimie Paris, 75005 Paris, France
| | - Virginie Lair
- Chimie
ParisTech, PSL University, CNRS, Institut
de Recherche de Chimie Paris, 75005 Paris, France
| | - Armelle Ringuedé
- Chimie
ParisTech, PSL University, CNRS, Institut
de Recherche de Chimie Paris, 75005 Paris, France
| | - Frédéric Prima
- Chimie
ParisTech, PSL University, CNRS, Institut
de Recherche de Chimie Paris, 75005 Paris, France
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Høl PJ, Gjerdet NR, Jonung T. Corrosion and metal release from overlapping arterial stents under mechanical and electrochemical stress – An experimental study. J Mech Behav Biomed Mater 2019; 93:31-35. [DOI: 10.1016/j.jmbbm.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/06/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
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Cools B, Brown S, Wevers M, Humbeeck JV, Boshoff D, Verdonckt C, Gewillig M. Right ventricle outflow tract prestenting: In vitro testing of rigidity and corrosion properties. Catheter Cardiovasc Interv 2018; 91:285-291. [PMID: 28895283 DOI: 10.1002/ccd.27320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/20/2017] [Accepted: 08/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to assess the resistance to compression (stiffness) of frequently used stents for right ventricular outflow tract prestenting. In addition, to assess the corrosion potential when different types of stent alloys come into contact with each other. METHOD Different stents were tested in vitro in various combinations at specialized metallurgic laboratories. A bench compression test was used to assess resistance to compression of singular and joined combinations of stents. Corrosion was evaluated by standardized electrochemical galvanic tests in physiological solutions at 37°C. Single stents and combinations of stents were evaluated over a period of 4-12 weeks. RESULTS Relative stiffness of the stents Optimus/Andrastent XXL/Intrastent LD Max/8zig Cheatham-Platinum, expressed as load per length to deform the stent for 1 mm at 22 mm was 100/104/161/190. Adding additional stents to a single stent significantly strengthened the joined couples (P < 0.001). The lowest galvanic corrosion rates (about 0.000001 mm/year) were observed for the joined CP-Andrastent, Andra-Sapien, and Andra-SapienXT. The corrosion rate for coupled CP-Sapien and CP-SapienXT was somewhat higher (about 0.000003 mm/year). The materials with the highest corrosion rates resulted in material losses of, respectively, 17 and 24 µg/year, which is negligible over a lifetime. CONCLUSION Adding stents to a single stent significantly increases stiffness which will reduce the risk of metal fatigue failure. Corrosion of individual stents or stent combinations occurs, but is negligible over a human lifetime with low risk of biological effects. No mechanical integrity problems are thus expected as there is only 0.3% of the initial diameter of the struts of a stent that will be lost as a consequence of corrosion after 100 years.
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Affiliation(s)
- Bjorn Cools
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium
| | - Stephen Brown
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium.,Pediatric Cardiology, University of the Free State, Bloemfontein, South Africa
| | - Martine Wevers
- Department of Metallurgy and Materials Engineering, University of Leuven, Leuven, Belgium
| | - Jan Van Humbeeck
- Department of Metallurgy and Materials Engineering, University of Leuven, Leuven, Belgium
| | - Derize Boshoff
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium
| | - Cis Verdonckt
- Corrosion Engineering, Metalogic, Rotselaar, Belgium
| | - Marc Gewillig
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium
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Wierzbicki MA, Raines SB, Gordon SG, Criscione JC, Saunders AB, Birch S, Due B, Keller B, Nash LD, Miller MW, Maitland DJ. An experimental canine patent ductus arteriosus occlusion device based on shape memory polymer foam in a nitinol cage. J Mech Behav Biomed Mater 2017; 75:279-292. [PMID: 28759840 DOI: 10.1016/j.jmbbm.2017.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/01/2022]
Abstract
Patent ductus arteriosus (PDA) is a congenital cardiovascular defect in which a fetal connection between the aorta and pulmonary artery does not spontaneously close shortly after birth. If left uncorrected serious complications and even death can occur. Surgical ligation is the traditional treatment method; however, it is an invasive procedure, that motivates development of a minimally invasive option. Shape memory polymer (SMP) foams are unique materials that hold promise in the field of minimally invasive occlusion devices. In this work, a prototype nitinol foam cage (NFC) incorporating SMP foams has been designed and evaluated in multiple mechanical and in vitro verification tests. The NFC demonstrated acceptable fatigue resistance in a preliminary strut integrity test, withstanding one million cycles without complete strut fracture. Radial force analysis of both thick- and thin-walled prototype variations generated less vessel distension and wall tension in a vessel mimic compared to a commercial device. The NFCs exhibited negligible in vitro migration, comparable to that of a commercial device, using simplified, ideal models of PDA. Deployment characteristics of the prototypes were evaluated and compared to that of a commercial device when delivered into physiological models of PDA. During mock deployments, a veterinary cardiologist noted that, while deliverable, the thin-walled NFC prototype exhibited poor deployment characteristics, however the thick-walled NFC had deployment characteristics comparable to that of a commercial device. The promising results of this study warrant further investigation of the NFC device for canine PDA closure.
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Affiliation(s)
- Mark A Wierzbicki
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Sarah B Raines
- Department of Electrical Engineering, Texas A&M University, USA
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences of Veterinary Medicine and Biomedical Sciences, Texas A&M University, USA
| | - John C Criscione
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences of Veterinary Medicine and Biomedical Sciences, Texas A&M University, USA
| | - Scott Birch
- The Center for Educational Technologies, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, USA
| | - Bradley Due
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Brandis Keller
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Landon D Nash
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Matthew W Miller
- Texas Institute for Preclinical Studies, Texas A&M University, MS 4478, College Station, TX 77845, USA
| | - Duncan J Maitland
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA.
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Matsagkas MI, Kouvelos G, Spanos K, Athanasoulas A, Giannoukas A. Double fixation for abdominal aortic aneurysm repair using AFX body and Endurant proximal aortic cuff: mid-term results. Interact Cardiovasc Thorac Surg 2017; 25:1-5. [DOI: 10.1093/icvts/ivx087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/18/2017] [Indexed: 11/13/2022] Open
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