Fenestrated and Branched Endografts: Assessment of Proximal Aortic Neck Fixation

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. Method...

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Bibliographic Details
Published in:Journal of endovascular therapy 2005-12, Vol.12 (6), p.647-653
Main Authors: Linsen, Matteus A.M., Vos, A. W. Floris, Diks, Jeroen, Rauwerda, Jan A., Wisselink, Willem
Format: Article
Language:English
Subjects:
Aorta, Abdominal - surgery
Aortic Aneurysm, Abdominal - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - methods
Cadaver
Humans
Prosthesis Design
Statistics, Nonparametric
Stents
Stress, Mechanical
Treatment Outcome
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Summary: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.
ISSN:1526-6028
1545-1550
DOI:10.1583/05-1639R.1