An Experimental Study of Laser in situ Fenestration of Current Aortic Endografts

Jayet, Jérémie; Heim, Frédéric; Coggia, Marc; Chakfé, Nabil; Coscas, Raphaël

doi:10.1016/j.ejvs.2018.03.016

Cited by 38 publications

(16 citation statements)

References 26 publications

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“…Recent work demonstrates that both laser and mechanical in situ fenestrations cause substantial damage to all available stent-graft fabrics. 219 The multilayer (or flow modulator) technique has recently been advocated for the treatment of various thoracic and abdominal aortic pathology including the aortic arch. The principle of the technique is formed by a self-expanding multilayered stent constructed of cobalt alloy wires interconnected in 5 layers.…”

Section: Classmentioning

confidence: 99%

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Czerny¹,

Schmidli²,

Adler³

et al. 2019

European Journal of Vascular and Endovascular Surgery

252

122

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Section: Classmentioning

confidence: 99%

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Czerny¹,

Schmidli²,

Adler³

et al. 2019

European Journal of Vascular and Endovascular Surgery

252

122

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“…Third, a 5 × 5 mm prefenestration on Valiant Stent Grafts then engaged with stent grafts was confirmed safety and integrity in a 5-year stimulated fatigue test and a median 38.9-month clinical follow-up. Although in-vitro experiment showed that a laser or needle effectively generated a hole in the membrane, the controllability was severely affected by the aortic pulsation in vivo ( 24 , 27 ). The laser may cause serious damage to the membrane, which resulted in junction weakness and gutter leakage ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although in-vitro experiment showed that a laser or needle effectively generated a hole in the membrane, the controllability was severely affected by the aortic pulsation in vivo ( 24 , 27 ). The laser may cause serious damage to the membrane, which resulted in junction weakness and gutter leakage ( 27 ). In the fatigue test of this study, no obvious damage was found beyond the fenestration at 262,800,000 cardiac cycles.…”

Section: Discussionmentioning

confidence: 99%

The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

Pei¹,

Zhu²,

Xiao³

et al. 2022

Front. Cardiovasc. Med.

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Objective: To examine the feasibility, integrity, efficacy, and safety of endovascular repair of the aortic arch pathologies with the mini-cross prefenestration (MCPF) on stent grafts.Methods: First, to prove the feasibility of the MCPF, an in-vitro prefenestration experiment was conducted. Second, to examine the integrity of the MCPF stent grafts, a fatigue test was conducted. Then, the membranes and metal structures of stent grafts were examined by light microscopy and scanning electron microscopy (SEM). Third, a clinical experiment was conducted to investigate the efficacy and safety of this novel technique (ClinicalTrials.gov Identifier: NCT04544579).Results: All the 12 branch stents were successfully implanted and flared in vitro. After the fatigue test stimulating a 5-year cardiac cycle, no obvious disintegration or fracture was found in light microscopy or SEM. From December 2017 to February 2020, 26 patients with left subclavian arteries and/or left common carotid arteries involved received the novel technique. The endovascular repair with the MCPF was successfully performed on all the 26 (100%) patients. Eighteen (69.2%) patients underwent the reconstruction of the left subclavian artery (LSCA) only. The fenestrations of both the LSCA and left common carotid artery (LCCA) were conducted in 8 (30.8%) patients. Median operative time was 120 [interquartile range (IQR), 95–137.5] min and median revascularization time of the LSCA and LCCA was 30.5 (IQR, 22.8–42.0) s and 20.0 (IQR, 18.0–32.0) s separately. During the median follow-up duration of 38.9 (range, 18.8–44.2) months, one case needed an open surgery because of retrograde type A aortic dissection 3 months after implantation and no other complications or mortality occurred. The maximum aortic diameters were significantly decreased in patients with thoracic aortic dissection and thoracic aortic aneurysm (p < 0.05).Conclusion: The existing evidence demonstrated the safety, rapid branch artery revascularization, and positive aortic remodeling of the novel technique. Long-term observation is warranted to prove the durability.

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“…Fenestration using laser energy is favorable for the following reasons: (1) perforation is reproducible and efficient, (2) the need for cutting balloon (and associated destruction) is obviated, and (3) laser fenestration can reliably perforate most graft material (ie, PET, PTFE, and expanded PTFE [ePTFE]). 24–27 The issue of laser fenestration of ePTFE devices demands more in-depth investigation because the literature has focused on plain PTFE only, 17 whereas surface modifications of PET after fenestration are inadequately documented. 28 Regardless, each technique (ie, laser, radiofrequency, or needle) has its strengths and weaknesses, and further head-to-head studies are needed to determine superiority.…”

Section: Discussionmentioning

confidence: 99%

Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts

et al. 2021

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Purpose: To evaluate the response of various stent-grafts after laser fenestration and dilation with noncompliant balloons to determine the optimal therapeutic combination for this treatment technique. Materials and Methods: Five aortic stent-grafts were evaluated ex vivo: the Bolton RelayPlus, Jotec E-vita Thoracic 3G, Medtronic Valiant, Cook Zenith Alpha, and Vascutek Anaconda. Small holes were created using an excimer laser with the grafts submerged in saline. Five rows of 5 fenestrations were created, 4 holes in each row were dilated once with a 6-, 8-, 10-, or 12-mm-diameter noncompliant balloon to the specified nominal pressure (one hole served as the control). The saline solution from each stent-graft was collected and qualitatively analyzed for debris. The fenestrations were evaluated under light and scanning electron microscopes. The maximum diameter and area for each fenestration were measured. The direction and length of tears were assessed. Results: The fenestration was feasible and reproducible in all the stent-grafts. The mean area of fenestration ranged from 7.63±1.63 to 14.75±0.73 mm2 when using balloons of 6- and 8-mm diameter, respectively. The 10- and 12-mm-diameter balloons caused a significant increase in area, variability, and tearing. The Anaconda graft tended to tear in the weft direction, while the other devices tore in the warp direction when using the 10- and 12-mm-diameter balloons. Dilation of the RelayPlus and Anaconda grafts with 6- and 8-mm-diameter balloons provided minimal tearing and precise fenestrations. Melted fiber remnants were observed after filtration of the saline solution for all devices. Conclusion: Laser fenestration and dilation with noncompliant balloons is a relatively simple and reproducible option for revascularization in urgent, complex aortic endovascular repairs. In our model, large balloons (ie, >10 mm) increased the destruction and tearing of the fabric. The maximum dilation recommended is 6 to 8 mm to avoid significant tears. Development of stent-grafts or novel fabrics designed explicitly for fenestration is needed to reduce potential complications.

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An Experimental Study of Laser in situ Fenestration of Current Aortic Endografts

Abstract: This study demonstrates that both LISF and MISF create substantial damage to all available endograft fabrics. Until comparisons with reinforced fenestrations are performed, LISF and MISF should not be used outside investigational studies.

Cited by 38 publications

References 26 publications

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies

Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts

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