Bridging Stent-Graft Pullout Force Analysis

Grenville, Jeffrey; Tan, Kong Teng; Tse, Leonard W.; Rajan, Dheeraj K.; Lindsay, Thomas F.

doi:10.1583/10-3284mr.1

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…3 Furthermore, both the pullout and shear forces needed to dislocate the stent-grafts from the fenestrations were significantly higher among BeGraft+ devices and throughout subgroup analysis, which suggests that the material and engineering alterations made for the newer device design did increase material stability. Nevertheless, when compared with pullout testing in branched grafts, 10 both devices show superior results to other bridging stent-grafts.…”

Section: Discussionmentioning

confidence: 94%

Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

et al. 2019

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Purpose: To investigate 2 generations of balloon-expandable covered stents as potential bridging devices using an in vitro model of stent-graft fenestrations. Materials and Methods: Twenty BeGraft and 20 BeGraft+ cobalt-chromium stents covered in expanded polytetrafluoroethylene (ePTFE) in 6- and 8-mm diameters were tested in sheets mimicking stent-graft fenestrations. Microscopy and radiography were employed to evaluate stent morphology after flaring. In vitro bench tests measured maximum pullout (perpendicular displacement) and the shear stress (axial displacement) forces needed to dislocate the stents. Results: No alteration of ePTFE coverage was detected in the flared stents. Digital radiography and computed tomography showed marked alteration of the stent geometry, which was more pronounced in the BeGraft group. No fractures were detected. Median (minimum–maximum) pullout forces for the 6-mm stent-grafts were 17.1 N (15.8–19.6) for the BeGraft device and 30.4 N (20.2–31.9) for the BeGraft+ device (p=0.006). Median (minimum–maximum) pullout forces for the 8-mm stent-grafts were 11.3 N (11–12.1) for the BeGraft device and 21.8 N (18.2–25.5) for the BeGraft+ device (p<0.001). The shear stress test showed median forces of 10.5 vs 15.28 N at 150% of the stent diameter for the 6-mm BeGraft and BeGraft+ stent-grafts, respectively, and 15.23 vs 20.72 N at 150% stent diameter for the 8-mm models (p=0.016 and 0.017, respectively). Conclusion: Flaring changed the stent geometry but did not provoke stent fractures. The BeGraft+ is superior to the BeGraft in terms of pullout and shear stress forces, demonstrating greater resilience.

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Section: Discussionmentioning

confidence: 94%

Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

et al. 2019

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“…However, a few hypotheses might aid in inferring these forces. In the study by Grenville et al, 11 the median pullout force needed to fully dislodge the stent-grafts varied between 1.17 and 3.79 N for the different bridging stent-grafts analyzed. In comparison to these results, the VBX demonstrated markedly higher pullout force resistance.…”

Section: Discussionmentioning

confidence: 94%

“…As the VBX has only recently been introduced and has been mainly utilized in aortoiliac occlusive disease, there are no clinical data on the performance of this stent-graft in f/bEVAR. To our knowledge, there has not been any thorough in vitro testing of bridging stent-grafts in fEVAR, though Grenville et al 11 evaluated pullout forces in branched EVAR using a slightly older generation of stent-grafts (Atrium i-Cast, Viabahn, Fluency, and Fluency+Zilver) and without the other tests performed in this study.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Evaluation of the Gore Viabahn Balloon-Expandable Stent-Graft for Fenestrated Endovascular Aortic Repair

et al. 2019

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Purpose: To evaluate the safety and integrity of a new stent-graft as a potential bridging device in fenestrated stent-grafts using an in vitro fenestrated model. Materials and Methods: Polyester test sheets with ten 6-mm- or 8-mm-diameter fenestrations were used to simulate a fenestrated main body endoprosthesis. In total, 50 Viabahn balloon-expandable (VBX) stent-grafts of varying lengths (29 and 39 mm) and diameters (6, 7, and 8 mm) were implanted in the fitting fenestrations. After release, the 6- and 7-mm-diameter stent-grafts were flared with a 10×20-mm angioplasty balloon; a 12×20-mm balloon was used in the 8-mm-diameter devices. Safety of the devices was defined as absence of fractures detected on radiography or computed tomography (CT), as well as material failure detected by microscopy and water permeability testing. The forces (in Newtons, N) needed for perpendicular dislocation (pullout force) and axial dislocation (shear stress force) were also evaluated. Results: Forty VBX stent-grafts were subjected to digital radiographic imaging and multiplanar CT. None showed any stent fracture. Subsequent microscopy indicated no damage to the fabric or separation of the graft after flaring. Ten VBX stent-grafts underwent water permeability testing after flaring; no water passed through the graft wall during a 10-minute period under an intraluminal pressure at 120 mm Hg. Testing of 25 VBX stent-grafts revealed initial pullout forces between 11.3 and 31 N. Shear stress tests showed that the average force needed to dislocate the stent-grafts by 50% of their diameter ranged between 5.75 and 6.91 N (mean 6.1±0.5 N) for the 6-mm stents and between 3.31 and 5.4 N (mean 4.4±0.8) for the 8-mm stents. Conclusion: This preliminary study demonstrated the applicability of the VBX as a bridging stent-graft in a simulated fenestration model. A comparison with other stent-grafts and clinical assessment are required.

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“…Regarding the pullout forces of the different bridging stent-grafts, Grenville et al. 16 demonstrated in vitro that Fluency supported by a Zilver bare stent (Fluency+Zilver) had a greater pullout force compared to Fluency alone. Fluency is fairly rigid and lacks conformability, which gives it a tendency to kink.…”

Section: Discussionmentioning

confidence: 99%

Technical Considerations and Performance of Bridging Stent-Grafts for Iliac Side Branched Devices Based on a Pooled Analysis of Single-Center Experiences

Donas¹,

Bisdas²,

Torsello³

et al. 2012

Journal of Endovascular Therapy

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Bridging Stent-Graft Pullout Force Analysis

Cited by 13 publications

References 27 publications

Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

In Vitro Evaluation of the Gore Viabahn Balloon-Expandable Stent-Graft for Fenestrated Endovascular Aortic Repair

Technical Considerations and Performance of Bridging Stent-Grafts for Iliac Side Branched Devices Based on a Pooled Analysis of Single-Center Experiences

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