Laser Fenestration of Aortic Stent-Grafts Followed by Noncompliant vs Cutting Balloon Dilation: A Scanning Electron Microscopy Study

Abstract

In situ fenestration does not cause any melting of the polyester; however, the observed structural damage to the fabric construction must be carefully considered. Cutting balloons caused various levels of tearing compared to the noncompliant balloons and cannot be recommended for use in this application. Rather, noncompliant balloons should be employed, but only with endografts constructed from multifilament yarns. The use of in situ fenestration must be restricted to urgent and emergent cases until long-term durability can be determined.

A New Adjustable Puncture Device for In Situ Fenestration During Thoracic Endovascular Aortic Repair

“…The Captivia endograft is made of monofilament twill polyester, while the Zenith has a multifilament polyester fabric. 14 There are reports that the Zenith Dacron graft is the most difficult to puncture and more durable, 8,13,14 but in this preliminary study, the 2 types of stent-grafts were almost equally easy to puncture.…”

Experimental Analysis of the Quality of Needle-Assisted Fenestration in Aortic Stent-Grafts and the Differences Between Gradual and Rapid Balloon Dilation

“…The Valiant and Hercules have 4/4 twill weaves with fewer interlacing points, while the Relay device has the fancy warp-backed weaves with more interlacing points. 16…”

“…17 However, the fact that thermal alteration in the ePTFE materials may release toxic molecular substances should also be considered. 16 Thus, these experiments used a needle to fenestrate both polyester and ePTFE stent grafts.…”

“…A cutting balloon has been shown to produce greater damage to the textile than a noncompliant balloon and is not recommended during ISF. 14–16…”

Commentary: Honing the Technique of In Situ Stent-Graft Fenestration

“…8 The challenge of ongoing, primarily physician-driven research is to create a safe, efficient, and durable fenestration to optimize blood flow while minimizing any risk of endoleak at the branching site. 9 Physician-modified reinforced fenestrations have been one proposed method, 8 but they are complex and time-consuming to construct and still carry the challenges of precision endograft placement and risks associated with maldeployment within complex vascular anatomy.…”