Custom-made Stent-Grafts for Aortic Aneurysm Repair Using Gianturco Z Stents and Woven Polyester: Healing in an Animal Model

Abstract

The purpose of this study was to evaluate the healing at 6 months of aortic stent-grafts custom-made by using Z stents and woven polyester in an animal model. Stent-grafts were built by a published method using autoexpandable stainless steel stents continuously compiled with polyester sutures and covered with a woven polyester membrane. Fourteen stent-grafts of 3 different designs were deployed under fluoroscopic control into the thoracic and the abdominal aorta of 7 adult sheep. At 6 months, all the implants of the sheep that survived the implantation were angiographed and harvested for macroscopy and microscopy. All stentgrafts were implanted successfully and remained patent from then to the explantation procedure. All stent-grafts implanted among the 6 of 7 (86%) animals that survived after the implantation remained patent, stayed free from local complications, and did not migrate during more than 6 months. In all these cases during this period, the implant functioned as a satisfactory aortic substitute while the aortic segment containing the graft kept a normal structure. There was no adverse effects of the presence of the implant upon the aorta or the animal. Stent-grafts home-made according to the described methods gave results at 6 months in this animal model compatible with a safe clinical application among humans.

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References

Koskas F , Cluzel P , Benhamou AC , et al: Endovascular treatment of aortoiliac aneurysms: Made-to-measure stent-grafts increase feasibility. Ann Vasc Surg 13:239-246, 1999.

Charnsangavej C , Wallace S , Wright KC , et al: Endovascular stent for use in aortic dissection: An in vitro experiment. Radiology 157:323-324, 1985.

Karube N , Noishiki Y , Yamamoto K , et al: Percutaneous insertion of a jacketed stent to close the entry of dissecting aortic aneurysms of DeBakey types I and II. Artif Organs 17:1004-1009, 1993.

Kato M , Matsuda T , Kotoh K , et al: Development of a chronic endothelialized transcatheter implantable intra-aortic graft. Asaio J 39:M518-M521, 1993.

Kato M , Ohnishi K , Kaneko M , et al: Development of an expandable intra-aortic prosthesis for experimental aortic dissection. Asaio J 39:M758-M761, 1993.

Kato N , Hirano T , Takeda K , et al: Treatment of acute aortic dissections with expandable metallic stents: Experimental study. J Vasc Interv Radiol 5:417-423, 1994.

Kato N , Hirano T , Takeda K , et al: Treatment of aortic dissections with a percutaneous intravascular endoprosthesis: Comparison of covered and bare stents. J Vasc Interv Radiol 5:805-812, 1994.

Lawrence-Brown MM , Hartley D , MacSweeney ST , et al: The Perth endoluminal bifurcated graft system — development and early experience. Cardiovasc Surg 4:706-712, 1996.

Malina M , Brunkwall J , Ivancev K , et al: Renal arteries covered by aortic stents: Clinical experience from endovascular grafting of aortic aneurysms. Eur J Vasc Endovasc Surg 14:109-113, 1997.

10.

Moon MR , Mitchell RS , Dake MD , et al: Simultaneous abdominal aortic replacement and thoracic stentgraft placement for multilevel aortic disease. J Vasc Surg 25:332-340, 1997.

11.

Semba CP , Kato N , Kee ST , et al: Acute rupture of the descending thoracic aorta: Repair with use of endovascular stent-grafts. J Vasc Interv Radiol 8:337-342, 1997.

12.

Yusuf SW , Whitaker SC , Chuter TA , et al: Early results of endovascular aortic aneurysm surgery with aortouniiliac graft, contralateral iliac occlusion, and femorofemoral bypass. J Vasc Surg 25:165-172, 1997.

13.

Dake MD , Kato N , Mitchell RS , et al: Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 340:1546-1552, 1999.

14.

Kaufman JA , Brewster DC , Geller SC , et al: Custom bifurcated stent-graft for abdominal aortic aneurysms: Initial experience. J Vasc Interv Radiol 10: 1099-1106, 1999.

15.

Albertini J , Kalliafas S , Travis S , et al: Anatomical risk factors for proximal perigraft endoleak and graft migration following endovascular repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 19: 308-312, 2000.

16.

Sawhney R , Chuter TA , Wall SD , et al: Aortic stentgrafts in patients with renal transplants. J Endovasc Ther 7:286-291, 2000.

17.

Rachel ES , Bergamini TM , Kinney EV , et al: Endovascular repair of thoracic aortic aneurysms: A paradigm shift in standard of care. Vasc Endovascular Surg 36:105-113, 2002.

18.

Park JH , Chung JW , Joh JH , et al: Aortic and arterial aneurysms in Behçet disease: Management with stent-grafts — initial experience. Radiology 220:745-750, 2001.

19.

Midorikawa H , Hoshino S , Iwaya F , et al: Graft-wall endoleak 18 months after successful endoluminal AAA repair. J Endovasc Surg 6:251-255, 1999.

20.

Malina M , Brunkwall J , Ivancev K , et al: Late aortic arch perforation by graft-anchoring stent: Complication of endovascular thoracic aneurysm exclusion. J Endovasc Surg 5:274-277, 1998.

21.

Desgranges P , Kobeiter H , Coumbaras M , et al: [Transluminal treatment of abdominal aortic aneurysms. Might one obstruct the renal arteries?] J Mal Vasc 23:385-386, 1998.

22.

Izzedine H , Koskas F , Cluzel P , et al: Renal function after aortic stent-grafting including coverage of renal arterial ostia. Am J Kidney Dis 39:730-736, 2002.