Delayed rupture of aortic aneurysms following endovascular stent grafting

Lumsden, Alan B.; Allen, Robert C.; Chaikof, Elliot L.; Resnikoff, Michael; Moritz, Mark W.; Gerhard, Harvey; Castronuovo, John J.

doi:10.1016/s0002-9610(99)80280-3

Cited by 217 publications

(91 citation statements)

References 24 publications

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“…Stent grafts depend upon a number of factors such as the radial force, the columnar strength, and the presence of hooks or barbs to remain stable in position since they are not sutured to the aortic wall and hence they are susceptible to migration. This has the potential to cause attachment-site endoleak and even a consequent aneurysm rupture [3,4,[8][9][10]. A deployed stent graft constantly faces physiological forces that tend to cause stent-graft migration and therefore stent grafts should be designed to resist such migration.…”

Section: Discussionmentioning

confidence: 99%

Measurement of pulsatile haemodynamic forces in a model of a bifurcated stent graft for abdominal aortic aneurysm repair

Zhou

How

Black

et al. 2008

Proc Inst Mech Eng H

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The longitudinal haemodynamic force (LF) acting on a bifurcated stent graft for abdominal aortic aneurysm repair has been estimated previously using a simple one-dimensional analytical model based on the momentum equation which assumes steady flow of an inviscid fluid. Using an instrumented stent-graft model an experimental technique was developed to measure the LF under pulsatile flow conditions. The physical stent-graft model, with main trunk diameter of 30mm and limb diameters of 12 mm, was fabricated from aluminium. Strain gauges were bonded on to the main trunk to determine the longitudinal strain which is related to the LF. After calibration, the model was placed in a pulsatile flow system with 40 per cent aqueous glycerol solution as the circulating fluid. The LF was determined using a Wheatstone bridge signal-conditioning circuit. The signals were averaged over 590 cardiac cycles and saved to a personal computer for subsequent processing. The LF was strongly dependent on the pressure but less so on the flowrate. The measured forces were higher than those predicted by the simplified mathematical model by about 6-18 per cent during the cardiac cycle. The excess measured forces are due to the viscous drag and the effect of pulsatile flow. The peak measured LF in this model of 30 mm diameter may exceed the fixation force of some current clinical endovascular stent grafts.

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Section: Discussionmentioning

confidence: 99%

Measurement of pulsatile haemodynamic forces in a model of a bifurcated stent graft for abdominal aortic aneurysm repair

Zhou

How

Black

et al. 2008

Proc Inst Mech Eng H

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“…24 In addition, several authors have shown that after endovascular exclusion, there are still 30% to 40% of cases in which a persistent endoleakage, associated with continuous sac pressurization, aneurysm growth, and increased risk of rupture, is present at 1-year follow-up. 21,[25][26][27][28] To date, clinical diagnosis of endoleakage relies exclusively on multiple CT scan examinations during follow-up and additional angiographic evaluation for leakages thought to be relevant, 29 -31 with additional clinical management cost expenditure.…”

mentioning

confidence: 99%

Plasma Levels of Metalloproteinases-3 and -9 as Markers of Successful Abdominal Aortic Aneurysm Exclusion After Endovascular Graft Treatment

et al. 2001

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A spiral CT scan was performed at 6 months to detect presence of endoleaks. MMP-3 and MMP-9 levels were measured before EVG (nϭ30) and OSR (nϭ15) treatments and at 1, 3, and 6 months of follow-up by a sandwich ELISA technique. Healthy volunteers (nϭ10) were used as control subjects. Immunohistochemical staining for MMP-9 and MMP-3 was performed on tissue samples from surgical cases. Both MMP-9 and MMP-3 mean basal levels were significantly higher in patients affected by AAA than in control subjects (32.3Ϯ20.7 ng/mL for EVG and 28Ϯ9.9 ng/mL for OSR versus 8.9Ϯ2.5 ng/mL, 2PϽ0.05; 18.3Ϯ9.7 ng/mL and 26.7Ϯ10.8 ng/mL versus 8.2Ϯ5.3 ng/mL, 2PϽ0.001).In the OSR group, both MMP-9 and MMP-3 mean levels decreased after surgery (28Ϯ9.9 ng/mL at basal versus 14.7Ϯ6.6 ng/mL at 6 months, 2PϽ0.001; 26.7Ϯ10.8 versus 12Ϯ5.3 ng/mL; 2PϽ0.001). In the EVG group, a statistically significant difference at 6-month follow-up in MMP-9 and MMP-3 mean plasma values was detected in patients who had endoleakage in comparison with patients without endoleakage (44.3Ϯ20.7 versus 14.6Ϯ7.0 ng/mL, 2PϽ0.005; 25Ϯ11.5 versus 10.3Ϯ5.4 ng/mL, 2PϽ0.005). Conclusions-After EVG exclusion, MMP-9 and MMP-3 levels decreased to a level similar to that of patients undergoing OSR. In addition, a lack of decrease in MMP levels after EVG exclusion may help in identifying patients who will have endoleakage and consequent aneurysm expansion caused by continuous sac pressurization during follow-up.

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“…4,6,8,28,29 Nevertheless, Gilling-Smith et al 2 suggested that endotension represents a missed or undiagnosed endoleak characterized by a very slow flow rather than true aneurysm expansion in the absence of perigraft flow. This hypothesis has been supported by a recent study performed by Napoli et al 11 based on CEUS examinations of patients who underwent EVAR.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 For this reason, a strict surveillance of these patients is crucial to the early detection of the presence of endoleaks or the aneurysmal sac enlargement, which could be or could not be associated with endoleak; the aneurysmal sac enlargement not associated with endoleak is defined as endotension.…”

mentioning

confidence: 99%

Multidetector-Row Computed Tomography Angiography in Abdominal Aortic Aneurysm Treated With Endovascular Repair

Iezzi

Cotroneo²,

Filippone³

et al. 2008

Journal of Computer Assisted Tomography

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Delayed rupture of aortic aneurysms following endovascular stent grafting

Cited by 217 publications

References 24 publications

Measurement of pulsatile haemodynamic forces in a model of a bifurcated stent graft for abdominal aortic aneurysm repair

Measurement of pulsatile haemodynamic forces in a model of a bifurcated stent graft for abdominal aortic aneurysm repair

Plasma Levels of Metalloproteinases-3 and -9 as Markers of Successful Abdominal Aortic Aneurysm Exclusion After Endovascular Graft Treatment

Multidetector-Row Computed Tomography Angiography in Abdominal Aortic Aneurysm Treated With Endovascular Repair

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