TY - JOUR
T1 - Fenestrated and branched endografts
T2 - Assessment of proximal aortic neck fixation
AU - Linsen, Matteus A.M.
AU - Vos, A. W.Floris
AU - Diks, Jeroen
AU - Rauwerda, Jan A.
AU - Wisselink, Willem
PY - 2005/12
Y1 - 2005/12
N2 - Purpose: To investigate proximal fixation characteristics of different aortic endograft designs: a suprarenally placed fenestrated endograft, a modular branched endograft, an infrarenal endograft with suprarenal bare stent fixation, and the gold standard, a conventional hand-sewn anastomosis. Methods: Ten human cadaveric aortas were obtained at autopsy and transected 20 mm below the renal arteries to mimic an infrarenal aneurysm neck. In random order, the infrarenal, fenestrated, and branched endografts were deployed into the aorta. Using a hydraulic material testing machine, longitudinal load was applied to the distal end of each endograft until migration occurred, thus defining the displacement force (DF). Subsequently, a hand-sewn infrarenal anastomosis was tested in a similar manner. Results: The median DF was 4.67 N (3.82-6.37) for the infrarenal endograft, 9.17 N (8.03-10.81) for the fenestrated endograft, and 16.95 N (14.78-19.67) for the branched endograft. The differences in DF between the infrarenal and fenestrated endografts and between the fenestrated and branched designs were statistically significant (both p=0.005). The median force to dislodge the graft from the conventional anastomosis was 89.16 N (71.24-105.23). Conclusions: Suprarenally placed endografts, especially with additional branch grafts, provide improved proximal fixation compared to an infrarenal endograft with suprarenal bare stent fixation. However, none of the tested endografts approached the optimal, time-proven fixation, the hand-sewn anastomosis.
AB - Purpose: To investigate proximal fixation characteristics of different aortic endograft designs: a suprarenally placed fenestrated endograft, a modular branched endograft, an infrarenal endograft with suprarenal bare stent fixation, and the gold standard, a conventional hand-sewn anastomosis. Methods: Ten human cadaveric aortas were obtained at autopsy and transected 20 mm below the renal arteries to mimic an infrarenal aneurysm neck. In random order, the infrarenal, fenestrated, and branched endografts were deployed into the aorta. Using a hydraulic material testing machine, longitudinal load was applied to the distal end of each endograft until migration occurred, thus defining the displacement force (DF). Subsequently, a hand-sewn infrarenal anastomosis was tested in a similar manner. Results: The median DF was 4.67 N (3.82-6.37) for the infrarenal endograft, 9.17 N (8.03-10.81) for the fenestrated endograft, and 16.95 N (14.78-19.67) for the branched endograft. The differences in DF between the infrarenal and fenestrated endografts and between the fenestrated and branched designs were statistically significant (both p=0.005). The median force to dislodge the graft from the conventional anastomosis was 89.16 N (71.24-105.23). Conclusions: Suprarenally placed endografts, especially with additional branch grafts, provide improved proximal fixation compared to an infrarenal endograft with suprarenal bare stent fixation. However, none of the tested endografts approached the optimal, time-proven fixation, the hand-sewn anastomosis.
KW - Abdominal aortic aneurysm
KW - Branched stent-graft
KW - Endograft migration
KW - Experimental investigation
KW - Fenestrated stent-graft
KW - Proximal neck
KW - Stent-graft fixation
UR - http://www.scopus.com/inward/record.url?scp=30744479208&partnerID=8YFLogxK
U2 - https://doi.org/10.1583/05-1639R.1
DO - https://doi.org/10.1583/05-1639R.1
M3 - Article
C2 - 16363893
SN - 1526-6028
VL - 12
SP - 647
EP - 653
JO - Journal of endovascular therapy
JF - Journal of endovascular therapy
IS - 6
ER -