Benchtop quantification of gutter formation and compression of chimney stent grafts in relation to renal flow in chimney endovascular aneurysm repair and endovascular aneurysm sealing configurations
| Autor: | Erik Groot Jebbink, Cornelis H. Slump, Esmé J. Donselaar, Johannes T. Boersen, Simon P. Overeem, Michel M.P.J. Reijnen, Jean-Paul P.M. de Vries, Roeliene Starreveld |
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| Přispěvatelé: | Physics of Fluids, Multi-Modality Medical Imaging, Technical Medicine |
| Rok vydání: | 2016 |
| Předmět: |
Models
Anatomic medicine.medical_specialty Endoleak Computed Tomography Angiography medicine.medical_treatment 030204 cardiovascular system & hematology 030230 surgery Prosthesis Design Endovascular aneurysm repair Aortography Renal Circulation 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine Aneurysm Renal Artery Blood vessel prosthesis Risk Factors medicine.artery Materials Testing medicine Humans Aorta Abdominal Renal artery Vascular Patency Computed tomography angiography Aorta medicine.diagnostic_test business.industry Endovascular Procedures Models Cardiovascular Stent Thrombosis medicine.disease Surgery Blood Vessel Prosthesis Treatment Outcome Stents Cardiology and Cardiovascular Medicine business Nuclear medicine Aortic Aneurysm Abdominal |
| Zdroj: | Journal of vascular surgery, 66(5), 1565-1573. Elsevier |
| ISSN: | 1097-6809 0741-5214 |
| Popis: | Background The chimney technique has been successfully used to treat juxtarenal aortic aneurysms. The two main issues with this technique are gutter formation and chimney graft (CG) compression, which induce a risk for type Ia endoleaks and stent thrombosis, respectively. In this benchtop study, the geometry and renal artery flow of chimney endovascular aneurysm repair configurations were compared with chimney configurations with endovascular aneurysm sealing (ch-EVAS). Methods Seven flow phantoms were constructed, including one control and six chimney endovascular aneurysm repairs (Endurant [Medtronic Inc, Minneapolis, Minn] and AFX [Endologix Inc, Irvine, Calif]) or ch-EVAS (Nellix, Endologix) configurations, combined with either balloon-expandable or self-expanding CGs with an intended higher positioning of the right CG in comparison to the left CG. Geometric analysis was based on measurements at three-dimensional computed tomography angiography and included gutter volume and CG compression, quantified by the ratio between maximal and minimal diameter (D-ratio). In addition, renal artery flow was studied in a physiologic flow model and compared with the control. Results The average gutter volume was 343.5 ± 142.0 mm 3 , with the lowest gutter volume in the EVAS-Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) combination (102.6 mm 3 ) and the largest in the AFX-Advanta V12 (Atrium Medical Corporation, Hudson, NH) configuration (559.6 mm 3 ). The maximum D-ratio was larger in self-expanding CGs than in balloon-expandable CGs in all configurations (2.02 ± 0.34 vs 1.39 ± 0.13). The CG compression had minimal influence on renal volumetric flow (right, 390.7 ± 29.4 mL/min vs 455.1 mL/min; left, 423.9 ± 28.3 mL/min vs 410.0 mL/min in the control). Conclusions This study showed that gutter volume was lowest in ch-EVAS in combination with a Viabahn CG. CG compression was lower in configurations with the Advanta V12 than with Viabahn. Renal flow is unrestricted by CG compression. |
| Databáze: | OpenAIRE |
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