Geometrical consequences of kissing stents and the Covered Endovascular Reconstruction of the Aortic Bifurcation configuration in an in vitro model for endovascular reconstruction of aortic bifurcation

Abstract

Although nitinol self-expandable stents have a high stent conformation, the lowest radial mismatch was found in the CERAB (1) configuration, supporting the hypothesis that the CERAB configuration is the most anatomical and physiological reconstruction of the aortic bifurcation. Within the CERAB configuration, the two limbs are ideally positioned inside the tapering portion of the cuff, minimizing mismatch.

Flow and wall shear stress characterization after endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model

“…Flow in the endograft could not be assessed in this study as the graft material did not allow optical access, and as a result, flow near the bifurcation could not be assessed for the EVAR models. Transparent stent grafts 12 can be used to analyze the flow in these areas with laser PIV. Ultrasound PIV could overcome this problem.…”

“…Flow phantoms based on an inverse negative mold of a three-dimensional printed AAA model were fabricated (Fig 1, A). 11,12 Model geometry was based on a straightforward AAA anatomy with an infrarenal neck diameter of 28 mm, infrarenal neck length of 15 mm, and maximum AAA diameter of 55 mm. A summary of the aortoiliac anatomy of the flow model is provided in Table I.…”

Endovascular Treatment of Occlusive Lesions in the Aortic Bifurcation with Kissing Polytetrafluoroethylene-Covered Stents

“…Third, the geometry of the kissing stent configuration, especially radial mismatch, might have contributed to thrombus formation and subsequent stent occlusion (25)(26)(27). CBESs in a kissing stent configuration create a higher radial mismatch compared with the use of BMSs, in theory leading to thrombus formation by dead space perfusion (28). To create a more physiologic situation, the use of endovascular aneurysm repair devices and the covered endovascular reconstruction of the aortic bifurcation technique have been described (29,30).…”

Complete Entry and Re-entry Neutralization protocol in endovascular treatment of aortic dissection

“…However, there is room for compromise between effective coverage and sparing the flow to the branches. Combining the benefits of Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) (using amplification of the radial force of the infra-renal stent and lower radial mismatch) and Kissing Stents technique (sparing the branches) is called Extended Petticoat (e-Petticoat) and is compatible with the CERN protocol (Goverde et al, 2013;Groot Jebbink et al, 2017;Jebbink et al, 2015). Using BMS instead of covered stents in CERAB allows the flow to the branches along the gutters between the iliac parallel stent-grafts (Kazimierczak et al, 2018(Kazimierczak et al, , 2019a.…”