Histology and Electron Microscopy of Explanted Bifurcated Endovascular Aortic Grafts: Evidence of Early Incorporation and Healing

Shin, Chung K.; Rodino, William; Kirwin, Jon D.; Ramirez, José A.; Wisselink, Willem; Papierman, Gary; Panetta, Thomas F.

doi:10.1583/1074-6218(1999)006<0246:haemoe>2.0.co;2

Cited by 22 publications

(9 citation statements)

References 14 publications

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“…Although there have been only a handful of explant analyses published to date, [1][2][3][4] several reports have documented various failure mechanisms, including device component failure, migration and resultant endoleak, disconnection or misalignment of modular components, and failures related to inappropriate case selection for a particular device. [5][6][7][8] In each situation, the most feared complication is catastrophic aneurysm rupture.…”

mentioning

confidence: 99%

Failed AAA Endograft Exclusion Due to Type II Endoleak: Explant Analysis

White

Walot

Donayre³

et al. 2001

J Endovasc Ther

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mentioning

confidence: 99%

Failed AAA Endograft Exclusion Due to Type II Endoleak: Explant Analysis

White

Walot

Donayre³

et al. 2001

J Endovasc Ther

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“…The body of evidence supports the premise that graft healing mandates contact between the graft material and the arterial wall to achieve healing. 24 Incomplete apposition may wrinkle the luminal surface and interfere with the growth of the acellular layer of fibrinous material or even promote thrombus formation. We have noticed in 3 more cases in this series dissection-like flaps and linear or circumferential thrombus at the distal part of the endografts and in all these cases there was >20% distal oversizing of the stent graft.…”

Section: Discussionmentioning

confidence: 99%

Midterm Results Following Endovascular Repair of Blunt Thoracic Aortic Injuries

Lioupis

MacKenzie

Corriveau

et al. 2012

Vasc Endovascular Surg

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“…Unfortunately, a number of clinical trials appeared but in retrospect may have been premature as evolutive complications were not uncommon. Numerous reports were published, mostly as individual cases, with different proposed modes of failure [10][11][12][13][14][15]. The explanted devices were usually investigated in detail but destructively.…”

Section: Introductionmentioning

confidence: 99%

MRI Virtual Biopsies: Analysis of an Explanted Endovascular Device and Perspectives for the Future

Guidoin¹,

Zhang²,

Douville³

et al. 2006

Artificial Cells, Blood Substitutes, and Biotechnology

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Information that can be obtained by magnetic resonance imaging (MRI) of explanted endovascular devices must be validated as this method is non-destructive. Histology of such a device together with its encroached tissues can be elegantly performed after polymethymethacrylate (PMMA) embedding, but this approach requires destruction of the specimen. The issue is therefore to 241 determine if the MRI is sufficient to fully validate an explanted device based upon the characterization of an explanted specimen.An AneuRx device deployed percutaneously 25 months earlier in a 75-yearold patient was removed en bloc at autopsy together with the surrounding aneurysmal sac and segments of the upstream and downstream arteries. Macroscopic pictures were taken and a slice of the cross-section was processed for histology after polymethylmethacrylate (PMMA) embedding. For the magnetic resonance imaging investigation, the device was inserted in a Biospec 4.7 T MRI system with a 20 mm diameter birdcage resonator used for both emission and reception. A Spin-Echo (SE) was used to acquire both T1 proton density (PD) and T2 weighted images. A gradient-echo (GE) sampling of a free induction decay (GESFID) was used to generate multiple GE images using a single excitation pulse so that four images at different TE were obtained in the same acquisition.The selected explanted device was outstandingly well-healed compared to most devices harvested from humans. No inflammatory process was observed in contact or at distance of the materials. In MRI T1 images display no specific contrast and were homogeneous in the different tissues. The contrast was improved on proton density weighed images. On the T2 weighed images, the different areas were well indentified. The diffusion images displayed in the surrounding B region had the greatest diffusion coefficient and the greatest anisotropy.The MRI analysis of the explanted AneuRx device illustrates the possibilities of this technique to characterize the interaction of the endovascular graft with the surrounding tissues. MRI is a breakthrough to investigate explanted medical devices but it also can be advantageously used in vivo to obtain virtual biopsies, because real biopsies to determine the 3 Bs (biocompatibility, biofunctionality and bioresilience) cannot be carried out as they could obviously initiate infection and degradation of the foreign materials.

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Histology and Electron Microscopy of Explanted Bifurcated Endovascular Aortic Grafts: Evidence of Early Incorporation and Healing

Abstract: Bifurcated endovascular aortic grafts show inflammatory and mild foreign body reactions, collagen formation, and intimal ingrowth during healing. These findings are similar to some of the healing properties reported for sutured grafts, as well as other endovascular grafts.

Cited by 22 publications

References 14 publications

Failed AAA Endograft Exclusion Due to Type II Endoleak: Explant Analysis

Failed AAA Endograft Exclusion Due to Type II Endoleak: Explant Analysis

Midterm Results Following Endovascular Repair of Blunt Thoracic Aortic Injuries

MRI Virtual Biopsies: Analysis of an Explanted Endovascular Device and Perspectives for the Future

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