The best in vitro conditions for two and three parallel stenting during endovascular aneurysm repair
The aim of this study is to identify which endograft-parallel stent combinations and which degree of oversizing result in the most adequate fit in a juxtarenal abdominal aneurysmal neck, when using a double or triple parallel-stent (chimney) technique. In vitro silicon, juxtarenal, abdominal aortic...
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| Veröffentlicht in: | Journal of vascular surgery 2017-10, Vol.66 (4), p.1227-1235 |
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| creator | Mestres, Gaspar Yugueros, Xavier Apodaka, Ana Urrea, Rodrigo Pasquadibisceglie, Savino Alomar, Xavier Riambau, Vincent |
| description | The aim of this study is to identify which endograft-parallel stent combinations and which degree of oversizing result in the most adequate fit in a juxtarenal abdominal aneurysmal neck, when using a double or triple parallel-stent (chimney) technique.
In vitro silicon, juxtarenal, abdominal aortic aneurysmal neck models of different diameters, with two and three side-branches (simulating both the renal and superior mesenteric arteries), were constructed. Two different endografts of three diameters each, with two or three parallel stents (of 6 mm and 6 mm; or 6 mm, 6 mm, and 8 mm) were tested (Endurant-II endograft [Medtronic Inc, Santa Rosa, Calif] with balloon-expandable BeGraft stent [Bentley InnoMed, Hechingen, Germany] and an Excluder endograft [W. L. Gore and Associates, Flagstaff, Ariz] with self-expanding Viabahn stent [W. L. Gore and Associates]), applying three endograft-oversizing degrees: recommended (15%), excessive (30%), and over-excessive (40%). After remodeling, using the kissing-balloon technique at 37°C (98.6°F), 36 endograft-stent-oversizing models were scanned by computed tomography. The area of the gutters, parallel-stent compression, and main endograft infolding were recorded.
Increasing oversizing (15%, 30%, and 40%) revealed a nonsignificant propensity toward smaller gutters and similar parallel-stent compression, but it significantly augmented infolding, more in three parallel-stent models (0%, 0%, 67% and 0%, 33%, 83% of cases; P = .015 and .018, for two and three parallel-stent models; n = 36) and mainly for the Excluder-Viabahn combination. The Excluder-Viabahn showed significantly smaller gutters, but with higher stent compression, than Endurant-BeGraft combinations for both two and three parallel stents (8.2 mm2, 22.6 mm2; P = .002 and 14.4 mm2, 23.3 mm2; P = .009 gutter area; and 18%, 2%; P < .001 and 15%, 2%; P = .007 relative stent area compression, respectively).
Better endograft stent apposition was usually attained when using 30% oversizing during two and three parallel-stent techniques. Higher oversizing was related to nonsignificant smaller gutters but higher rates of infolding. Smaller gutters, but higher stent compression and risk of infolding, were achieved with the Excluder-Viabahn than with the Endurant-BeGraft combination.
This study is a continuation of our previous, innovative in vitro study, which analyzed the best endograft and one parallel-stent combination, but now analyzing the performance of two and thre |
| doi_str_mv | 10.1016/j.jvs.2016.09.046 |
| format | Article |
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In vitro silicon, juxtarenal, abdominal aortic aneurysmal neck models of different diameters, with two and three side-branches (simulating both the renal and superior mesenteric arteries), were constructed. Two different endografts of three diameters each, with two or three parallel stents (of 6 mm and 6 mm; or 6 mm, 6 mm, and 8 mm) were tested (Endurant-II endograft [Medtronic Inc, Santa Rosa, Calif] with balloon-expandable BeGraft stent [Bentley InnoMed, Hechingen, Germany] and an Excluder endograft [W. L. Gore and Associates, Flagstaff, Ariz] with self-expanding Viabahn stent [W. L. Gore and Associates]), applying three endograft-oversizing degrees: recommended (15%), excessive (30%), and over-excessive (40%). After remodeling, using the kissing-balloon technique at 37°C (98.6°F), 36 endograft-stent-oversizing models were scanned by computed tomography. The area of the gutters, parallel-stent compression, and main endograft infolding were recorded.
Increasing oversizing (15%, 30%, and 40%) revealed a nonsignificant propensity toward smaller gutters and similar parallel-stent compression, but it significantly augmented infolding, more in three parallel-stent models (0%, 0%, 67% and 0%, 33%, 83% of cases; P = .015 and .018, for two and three parallel-stent models; n = 36) and mainly for the Excluder-Viabahn combination. The Excluder-Viabahn showed significantly smaller gutters, but with higher stent compression, than Endurant-BeGraft combinations for both two and three parallel stents (8.2 mm2, 22.6 mm2; P = .002 and 14.4 mm2, 23.3 mm2; P = .009 gutter area; and 18%, 2%; P < .001 and 15%, 2%; P = .007 relative stent area compression, respectively).
Better endograft stent apposition was usually attained when using 30% oversizing during two and three parallel-stent techniques. Higher oversizing was related to nonsignificant smaller gutters but higher rates of infolding. Smaller gutters, but higher stent compression and risk of infolding, were achieved with the Excluder-Viabahn than with the Endurant-BeGraft combination.
This study is a continuation of our previous, innovative in vitro study, which analyzed the best endograft and one parallel-stent combination, but now analyzing the performance of two and three parallel stents. We have observed comparable results: 30% endograft oversizing is still probably the most optimal, and the Excluder-Viabahn combination is related to smaller gutters, but higher stent compression and risk of infolding, than with Endurant-BeGraft. Infolding was also greater with three than with two parallel stents. These novel in vitro results can be very useful in planning EVAR with several parallel-stent procedures, where there is a paucity of factual knowledge.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2016.09.046</identifier><identifier>PMID: 28662925</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aorta, Abdominal - diagnostic imaging ; Aorta, Abdominal - pathology ; Aorta, Abdominal - surgery ; Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - pathology ; Aortic Aneurysm, Abdominal - surgery ; Aortography ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - methods ; Computed Tomography Angiography ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Endovascular Procedures - methods ; Humans ; Models, Anatomic ; Models, Cardiovascular ; Prosthesis Design ; Silicon ; Stents</subject><ispartof>Journal of vascular surgery, 2017-10, Vol.66 (4), p.1227-1235</ispartof><rights>2016 Society for Vascular Surgery</rights><rights>Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-4abeca7a131468355d7b4252e4b1969fa3af90e44404419c48c8958613fb4d863</citedby><cites>FETCH-LOGICAL-c462t-4abeca7a131468355d7b4252e4b1969fa3af90e44404419c48c8958613fb4d863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2016.09.046$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28662925$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mestres, Gaspar</creatorcontrib><creatorcontrib>Yugueros, Xavier</creatorcontrib><creatorcontrib>Apodaka, Ana</creatorcontrib><creatorcontrib>Urrea, Rodrigo</creatorcontrib><creatorcontrib>Pasquadibisceglie, Savino</creatorcontrib><creatorcontrib>Alomar, Xavier</creatorcontrib><creatorcontrib>Riambau, Vincent</creatorcontrib><title>The best in vitro conditions for two and three parallel stenting during endovascular aneurysm repair</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>The aim of this study is to identify which endograft-parallel stent combinations and which degree of oversizing result in the most adequate fit in a juxtarenal abdominal aneurysmal neck, when using a double or triple parallel-stent (chimney) technique.
In vitro silicon, juxtarenal, abdominal aortic aneurysmal neck models of different diameters, with two and three side-branches (simulating both the renal and superior mesenteric arteries), were constructed. Two different endografts of three diameters each, with two or three parallel stents (of 6 mm and 6 mm; or 6 mm, 6 mm, and 8 mm) were tested (Endurant-II endograft [Medtronic Inc, Santa Rosa, Calif] with balloon-expandable BeGraft stent [Bentley InnoMed, Hechingen, Germany] and an Excluder endograft [W. L. Gore and Associates, Flagstaff, Ariz] with self-expanding Viabahn stent [W. L. Gore and Associates]), applying three endograft-oversizing degrees: recommended (15%), excessive (30%), and over-excessive (40%). After remodeling, using the kissing-balloon technique at 37°C (98.6°F), 36 endograft-stent-oversizing models were scanned by computed tomography. The area of the gutters, parallel-stent compression, and main endograft infolding were recorded.
Increasing oversizing (15%, 30%, and 40%) revealed a nonsignificant propensity toward smaller gutters and similar parallel-stent compression, but it significantly augmented infolding, more in three parallel-stent models (0%, 0%, 67% and 0%, 33%, 83% of cases; P = .015 and .018, for two and three parallel-stent models; n = 36) and mainly for the Excluder-Viabahn combination. The Excluder-Viabahn showed significantly smaller gutters, but with higher stent compression, than Endurant-BeGraft combinations for both two and three parallel stents (8.2 mm2, 22.6 mm2; P = .002 and 14.4 mm2, 23.3 mm2; P = .009 gutter area; and 18%, 2%; P < .001 and 15%, 2%; P = .007 relative stent area compression, respectively).
Better endograft stent apposition was usually attained when using 30% oversizing during two and three parallel-stent techniques. Higher oversizing was related to nonsignificant smaller gutters but higher rates of infolding. Smaller gutters, but higher stent compression and risk of infolding, were achieved with the Excluder-Viabahn than with the Endurant-BeGraft combination.
This study is a continuation of our previous, innovative in vitro study, which analyzed the best endograft and one parallel-stent combination, but now analyzing the performance of two and three parallel stents. We have observed comparable results: 30% endograft oversizing is still probably the most optimal, and the Excluder-Viabahn combination is related to smaller gutters, but higher stent compression and risk of infolding, than with Endurant-BeGraft. Infolding was also greater with three than with two parallel stents. These novel in vitro results can be very useful in planning EVAR with several parallel-stent procedures, where there is a paucity of factual knowledge.</description><subject>Aorta, Abdominal - diagnostic imaging</subject><subject>Aorta, Abdominal - pathology</subject><subject>Aorta, Abdominal - surgery</subject><subject>Aortic Aneurysm, Abdominal - diagnostic imaging</subject><subject>Aortic Aneurysm, Abdominal - pathology</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Aortography</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - methods</subject><subject>Computed Tomography Angiography</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - methods</subject><subject>Humans</subject><subject>Models, Anatomic</subject><subject>Models, Cardiovascular</subject><subject>Prosthesis Design</subject><subject>Silicon</subject><subject>Stents</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLFu2zAQhomiQe0kfYAsAccuUnkSRYnoFBhpGyBAl2QmKPLU0JBFl6QU-G36LHmy0nCSsdPd8P0_7j5CroCVwEB83ZbbJZZVXksmS8bFB7IGJttCdEx-JGvWciiaCviKnMe4ZQyg6dpPZFV1QlSyatYEH56Q9hgTddPL38Wl4Knxk3XJ-SnSwQeanj3Vk6XpKSDSvQ56HHGkMeGU3PSb2jkcB07WLzqaedQh8ziHQ9zRgHvtwiU5G_QY8fPrvCCP328fNj-L-18_7jY394XhokoF1z0a3WqogYuubhrb9rxqKuQ9SCEHXetBMuScM85BGt6ZTjadgHroue1EfUG-nHr3wf-Z81dq56LBccz3-DkqkNDUvG1rmVE4oSb4GAMOah_cToeDAqaOdtVWZbvqaFcxqbLdnLl-rZ_7Hdr3xJvODHw7AZifXBwGFY3DyaB1AU1S1rv_1P8DfTGMfQ</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Mestres, Gaspar</creator><creator>Yugueros, Xavier</creator><creator>Apodaka, Ana</creator><creator>Urrea, Rodrigo</creator><creator>Pasquadibisceglie, Savino</creator><creator>Alomar, Xavier</creator><creator>Riambau, Vincent</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201710</creationdate><title>The best in vitro conditions for two and three parallel stenting during endovascular aneurysm repair</title><author>Mestres, Gaspar ; Yugueros, Xavier ; Apodaka, Ana ; Urrea, Rodrigo ; Pasquadibisceglie, Savino ; Alomar, Xavier ; Riambau, Vincent</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-4abeca7a131468355d7b4252e4b1969fa3af90e44404419c48c8958613fb4d863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aorta, Abdominal - diagnostic imaging</topic><topic>Aorta, Abdominal - pathology</topic><topic>Aorta, Abdominal - surgery</topic><topic>Aortic Aneurysm, Abdominal - diagnostic imaging</topic><topic>Aortic Aneurysm, Abdominal - pathology</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Aortography</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Blood Vessel Prosthesis Implantation - methods</topic><topic>Computed Tomography Angiography</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - methods</topic><topic>Humans</topic><topic>Models, Anatomic</topic><topic>Models, Cardiovascular</topic><topic>Prosthesis Design</topic><topic>Silicon</topic><topic>Stents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mestres, Gaspar</creatorcontrib><creatorcontrib>Yugueros, Xavier</creatorcontrib><creatorcontrib>Apodaka, Ana</creatorcontrib><creatorcontrib>Urrea, Rodrigo</creatorcontrib><creatorcontrib>Pasquadibisceglie, Savino</creatorcontrib><creatorcontrib>Alomar, Xavier</creatorcontrib><creatorcontrib>Riambau, Vincent</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mestres, Gaspar</au><au>Yugueros, Xavier</au><au>Apodaka, Ana</au><au>Urrea, Rodrigo</au><au>Pasquadibisceglie, Savino</au><au>Alomar, Xavier</au><au>Riambau, Vincent</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The best in vitro conditions for two and three parallel stenting during endovascular aneurysm repair</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2017-10</date><risdate>2017</risdate><volume>66</volume><issue>4</issue><spage>1227</spage><epage>1235</epage><pages>1227-1235</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>The aim of this study is to identify which endograft-parallel stent combinations and which degree of oversizing result in the most adequate fit in a juxtarenal abdominal aneurysmal neck, when using a double or triple parallel-stent (chimney) technique.
In vitro silicon, juxtarenal, abdominal aortic aneurysmal neck models of different diameters, with two and three side-branches (simulating both the renal and superior mesenteric arteries), were constructed. Two different endografts of three diameters each, with two or three parallel stents (of 6 mm and 6 mm; or 6 mm, 6 mm, and 8 mm) were tested (Endurant-II endograft [Medtronic Inc, Santa Rosa, Calif] with balloon-expandable BeGraft stent [Bentley InnoMed, Hechingen, Germany] and an Excluder endograft [W. L. Gore and Associates, Flagstaff, Ariz] with self-expanding Viabahn stent [W. L. Gore and Associates]), applying three endograft-oversizing degrees: recommended (15%), excessive (30%), and over-excessive (40%). After remodeling, using the kissing-balloon technique at 37°C (98.6°F), 36 endograft-stent-oversizing models were scanned by computed tomography. The area of the gutters, parallel-stent compression, and main endograft infolding were recorded.
Increasing oversizing (15%, 30%, and 40%) revealed a nonsignificant propensity toward smaller gutters and similar parallel-stent compression, but it significantly augmented infolding, more in three parallel-stent models (0%, 0%, 67% and 0%, 33%, 83% of cases; P = .015 and .018, for two and three parallel-stent models; n = 36) and mainly for the Excluder-Viabahn combination. The Excluder-Viabahn showed significantly smaller gutters, but with higher stent compression, than Endurant-BeGraft combinations for both two and three parallel stents (8.2 mm2, 22.6 mm2; P = .002 and 14.4 mm2, 23.3 mm2; P = .009 gutter area; and 18%, 2%; P < .001 and 15%, 2%; P = .007 relative stent area compression, respectively).
Better endograft stent apposition was usually attained when using 30% oversizing during two and three parallel-stent techniques. Higher oversizing was related to nonsignificant smaller gutters but higher rates of infolding. Smaller gutters, but higher stent compression and risk of infolding, were achieved with the Excluder-Viabahn than with the Endurant-BeGraft combination.
This study is a continuation of our previous, innovative in vitro study, which analyzed the best endograft and one parallel-stent combination, but now analyzing the performance of two and three parallel stents. We have observed comparable results: 30% endograft oversizing is still probably the most optimal, and the Excluder-Viabahn combination is related to smaller gutters, but higher stent compression and risk of infolding, than with Endurant-BeGraft. Infolding was also greater with three than with two parallel stents. These novel in vitro results can be very useful in planning EVAR with several parallel-stent procedures, where there is a paucity of factual knowledge.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28662925</pmid><doi>10.1016/j.jvs.2016.09.046</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aorta, Abdominal - diagnostic imaging Aorta, Abdominal - pathology Aorta, Abdominal - surgery Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - pathology Aortic Aneurysm, Abdominal - surgery Aortography Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - methods Computed Tomography Angiography Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Endovascular Procedures - methods Humans Models, Anatomic Models, Cardiovascular Prosthesis Design Silicon Stents |
| title | The best in vitro conditions for two and three parallel stenting during endovascular aneurysm repair |
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