Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: The significance of device design for long-term results

Krohg‐Sørensen, Kirsten; Brekke, Magne; Drolsum, Anders; Kvernebo, Knut

doi:10.1016/s0741-5214(99)70253-3

Cited by 64 publications

(40 citation statements)

References 6 publications

(8 reference statements)

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“…By imparting an ideal anatomical shape into the memory of a Nitinol stent, anatomic mismatch between the stent-graft and vessel can be minimized, thus potentially decreasing the incidence of endoleak [11,12], stent migration [12], or aortic rupture at the distal end of the stent-graft in the late follow-up period [12]. Krohg-Sørensen et al [13] reported that the angle and rotation of the aorta might be important to the force pulsation induced on the stent-graft in vivo. Our experimental testing proved that the anatomical stent significantly decreases the external strain force at both ends of the stent compare with that of the straight stent.…”

Section: Discussionmentioning

confidence: 99%

Creation of individual ideally shaped stents using multi-slice CT: in vitro results from the semi-automatic virtual stent (SAVS) designer

et al. 2005

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To plan stent-grafting for thoracic aortic aneurysm with complicated morphology, we created a virtual stent-grafting program [Semi Automatic Virtual Stent (SAVS) designer] using three-dimensional CT data. The usefulness of the SAVS designer was evaluated by measurement of transformed anatomical and straight stents. Curved model images (source, multi-planer reconstruction and volume rendering) were created, and a hollow virtual stent was produced by the SAVS designer. A straight Nitinol stent was transformed to match the curved configuration of the virtual stent. The accuracy of the anatomical stent was evaluated by experimental strain phantom studies in comparison with the straight stent. Mean separation length was 0 mm in the anatomical stent [22 mm outer diameter (OD)] and 5 mm in the straight stent (22 mm OD). The straight stent strain voltage was four times that of the anatomical stent at the stent end. The anatomical stent is useful because it fits the curved structure of the aorta and reduces the strain force compared to the straight stent. The SAVS designer can help to design and produce the anatomical stent.

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Section: Discussionmentioning

confidence: 99%

Creation of individual ideally shaped stents using multi-slice CT: in vitro results from the semi-automatic virtual stent (SAVS) designer

et al. 2005

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“…Placing a stent to support an Ancure limb effectively creates an endoskeleton, and although no instances of Ancure type III endoleaks have been identified to date (2-year to 4-year follow-up), other endografts with an endoskeletal design with sutures and thinner fabric have proven vulnerable to friction and fabric erosion, over time producing late endoleaks. 8,9 Whether the mechanism of failure is the result of the endoskeletal design model itself or the suturing of stents to fabric remains to be determined. However, the Ancure device is unlikely to be negatively impacted by Wallstents placed within its limbs.…”

Section: Discussionmentioning

confidence: 99%

Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: A review of the Phase II EVT Trial

Fairman

Baum

Carpenter

et al. 2002

Journal of Vascular Surgery

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The unsupported bifurcated limbs of this endograft necessitated primary adjunctive intervention in 40% of cases. Primary intervention was two times more likely to be performed at the time of the implant rather than after surgery. Repeat limb interventions were not common. Endograft limb flow problems were successfully treated with standard endovascular or surgical interventions or both. These data may support prophylactic stenting of unsupported Ancure graft limbs. A strategy that includes both intraoperative and early postoperative graft limb surveillance is essential to detect reduced limb flow.

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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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Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: The significance of device design for long-term results

Cited by 64 publications

References 6 publications

Creation of individual ideally shaped stents using multi-slice CT: in vitro results from the semi-automatic virtual stent (SAVS) designer

Creation of individual ideally shaped stents using multi-slice CT: in vitro results from the semi-automatic virtual stent (SAVS) designer

Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: A review of the Phase II EVT Trial

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

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