Endoluminal Repair of Aneurysms Containing Ostia of Essential Branch Arteries: An Experimental Model

Abstract

Purpose: To examine experimentally the feasibility of transfemoral endoluminal repair of aneurysms containing the ostia of essential branch arteries. Methods: In a canine model (n = 4), suprarenal aortic aneurysms were created by suturing an artificial patch onto an anterior arteriotomy. Following a 2-week recovery period, the dogs underwent endovascular exclusion of their aneurysms using an aortic stent-graft with separate renal artery branch grafts. Outcome was evaluated using angiography, intravascular ultrasound (IVUS), Doppler flow, invasive pressure monitoring, and autopsy, respectively. Results: Successful creation and subsequent endovascular exclusion of the aneurysm using aortic stent-grafts and separate bilateral renal artery stent-grafts was achieved in all trials. Angiographically, all aneurysms were excluded from aortic flow and all renal arteries were patent at completion of the procedure. With IVUS, good graft apposition and absence of perigraft flow were demonstrated in all animals. Mean pressure in the aneurysmal sac at completion of the procedure was 40 ± 7 mmHg, compared to a mean systemic blood pressure of 105 ± 8 mmHg (p < 0.05). At autopsy, no gross intimal damage was seen in the aorta or the renal arteries, and intact aortic grafts and branch grafts without twisting, coiling, or kinking were found in all trials. Conclusions: In an acute animal model, suprarenal aortic aneurysms can be excluded from the circulation with preservation of renal flow using an endoluminally placed aortic stent-graft with separate branch grafts.

Cine MRI Assessment of Aortic Aneurysm Dynamics before and after Endovascular Repair

“…7 In aneurysms with short proximal necks, transrenal graft fixation with uncovered stents or even branched stent-grafts are indicated to avoid migration in the long term. [8][9][10][11] Besides migration, there is an almost universal awareness that the long-term durability of stent-grafts must be carefully assessed because fabric erosion (type III endoleak) and wire fracture are increasingly common at longer followup. [12][13][14] In 4 patients, we observed the stentgraft bend with each systole at sites of angulation (Fig.…”

Fenestrated and Branched Endografts: Assessment of Proximal Aortic Neck Fixation

“…Reports have been mostly limited to animal studies and incidental case reports. [36][37][38] These procedures have proven technically challenging and time consuming and are therefore probably less suitable for use in a conventional endovascular unit. Nonetheless, the modular branched endograft system described in this study, although still in pre-clinical development, has proved it can be deployed in a reliable, predictable, and timely manner.…”

Commentary: Juxtarenal Aortic Aneurysm Repair: Are We Ready for a ParadigmRegression?

“…Since this journal's 1999 publication of the in vivo proof of concept of endovascular suprarenal aneurysm repair by means of transfemorally introduced fenestrated stent-grafts with separate modular renal branch grafts, 1 the platform has rapidly evolved to become indispensible in the armamentarium of modern vascular practice. Indeed, if the proven advantages of minimally invasive techniques for infrarenal aneurysm repair can be linearly extrapolated to suprarenal, thoracoabdominal, and arch aneurysms, the impact for our patients could be phenomenal: no more two body cavity incisions, no more aortic clamping, no more organ ischemia.…”