Mechanical Behaviour of Fenestrations in Current Aortic Endografts

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

doi:10.1016/j.ejvs.2021.08.020

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…Previous study results pointed out differences between the devices at various levels: (1) the radial strength of the fenestration; (2) the pull-out strength, and (3) the behavior under fatigue loading. We concluded that these differences could be related to variations in the construction of the devices [24]. We have observed a large range of values secondary to custom-made fenestration testing.…”

Section: Discussionmentioning

confidence: 84%

“…Tests were performed with equipment that is commonly used for the evaluation of vascular prostheses according to IS0/FDIS 7198. However, they had to be specifically adapted because the tests performed were not standard as previously described [22][23][24]. Due to a lack of material, the five fenestrations were tested in terms of their radial strength, branch pull-out strength, and cyclic fatigue.…”

Section: Samplesmentioning

confidence: 99%

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Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations

Jayet

Canonge

Heim

et al. 2023

JCM

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Introduction: A fenestrated endograft (FE) is the first-line endovascular option for juxta and pararenal abdominal aortic aneurysms. A physician-modified stent-graft (PMSG) and laser in situ fenestration (LISF) have emerged to circumvent manufacturing delays, anatomic standards, and the procedure’s cost raised by FE. The objective was to compare different fenestrations from a mechanical point of view. Methods: In total, five Zenith Cook fenestrations (Cook Medical, Bloomington, IN, USA) and five Anaconda fenestrations (Terumo Company, Inchinnan, Scotland, UK) were included in this study. Laser ISF and PMSG were created on a Cook TX2 polyethylene terephthalate (PET) cover material (Cook Medical, Bloomington, IN, USA). In total, five LISFs and fifty-five PMSG were created. All fenestrations included reached an 8 mm diameter. Radial extension tests were then performed to identify differences in the mechanical behavior between the fenestration designs. The branch pull-out force was measured to test the stability of assembling with a calibrated 8 mm branch. Fatigue tests were performed on the devices to assess the long-term outcomes of the endograft with an oversized 9 mm branch. Results: The results revealed that at over 2 mm of oversizing, the highest average radial strength was 33.4 ± 6.9 N for the Zenith Cook fenestration. The radial strength was higher with the custom-made fenestrations, including both Zenith Cook and Anaconda fenestrations (9.5 ± 4.7 N and 4.49 ± 0.28 N). The comparison between LISF and double loop PMSG highlighted a higher strength value compared with LISF (3.96 N ± 1.86 vs. 2.7 N ± 0.82; p= 0.018). The diameter of the fenestrations varied between 8 and 9 mm. As the pin caliber inserted in the fenestration was 9 mm, one could consider that all fenestrations underwent an “elastic recoil” after cycling. The largest elastic recoil was observed in the non-reinforced/OC fenestrations (40%). A 10% elastic recoil was observed with LISF. Conclusion: In terms of mechanical behavior, the custom-made fenestration produced the highest results in terms of radial and branch pull-out strength. Both PMSG and LISF could be improved with the standardization of the fenestration creation protocol.

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Section: Discussionmentioning

confidence: 84%

Section: Samplesmentioning

confidence: 99%

Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations

Jayet

Canonge

Heim

et al. 2023

JCM

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“…Jayet et al tested two commercially available fenestrated stent grafts under in vitro conditions [18]. These custom-made devices have fenestrations that are reinforced with nitinol rings, similar to the Hungaroring.…”

Section: Discussionmentioning

confidence: 99%

“…They found that the diameter of the fenestrations increased during the cyclic fatigue test, but there was a significant difference between the two stent graft systems tested. These notable results suggest that the material of the stent graft, the type of reinforcement as well as the anchorage of the reinforcement may affect the long-term stability of the fenestrations [18].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations—An In Vitro Study

Hüttl,

Nguyen,

Borzsák

et al. 2024

JCDD

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Background: We conducted an in vitro comparison of the snare loop reinforcement against a closed-loop reinforcement (Hungaroring) for physician-modified endograft (PMEG) fenestrations regarding preparation time and stability during flaring balloon dilatation. Materials and methods: The time to complete a PMEG fenestration with reinforcement was measured and compared between the Hungaroring and snare loop groups. The number of stitches was counted. Each fenestration was dilated using a 10 mm high-pressure, non-compliant balloon up to 21 atm in pressure, and fluoroscopic images were taken. The presence of indentation on the oversized balloon at the level of the reinforcement was evaluated at each fenestration. Results: Five fenestrations were created in each group (n = 5) for a total of ten pieces. The completion time in the snare loop group was 1070 s (IQR:1010–1090) compared to 760 s (IQR:685–784) in the Hungaroring group (p = 0.008). Faster completion time was achieved by faster stitching (23.2 s/stitch (IQR 22.8–27.3) for the snare loop group and 17.3 s/stitch (IQR 17.3–20.1) for the Hungaroring group (p = 0.016). None of the fluoroscopic images of the snare loop reinforcement showed an indentation on the balloon during the overexpansion; on the contrary, the Hungaroring showed indentation in every case, even at 21 atm. Conclusion: Fenestrations reinforced with Hungaroring can be completed significantly faster. Furthermore, the Hungaroring resists over-dilation even at high pressures, while snare loop reinforcements dilate at nominal pressure.

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“…To our knowledge, in clinical practice of ISF-TEVAR involving LSA reconstruction, the modification mode of the main stent and the connection between the main stent and the branch stent are not completely consistent with theoretical research. For instance, the branch stent often protrudes into the aortic arch to prevent migration, which may lead to branch stent overextension ( 11 , 12 ). Additionally, fenestration and branch stent implantation for type III aortic arches tends to trigger long-term complications caused by narrow angles or long-stent extension lengths.…”

Section: Introductionmentioning

confidence: 99%

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

Qiu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe study of hemodynamics regarding thoracic endovascular aortic repair (TEVAR) is helpful to improve the surgical efficacy.ObjectiveCorrelations between hemodynamic changes and branch stent extension length and interference factors for branch stent extension length of in situ fenestration TEVAR (ISF-TEVAR) involving the left subclavian artery (LSA) were evaluated.Materials and MethodsThis study retrospectively analyzed 196 patients with Stanford type B aortic dissection who received in situ laser fenestrated thoracic endovascular aortic repair with LSA fenestration from April 2014 to March 2021. Branch stent extension to the main stent graft was evaluated by the computed tomographic angiography (CTA). Hemodynamic change of LSA was defined as a 20 mmHg interbrachial systolic pressure difference. The factors affecting the extension of the branch stent were also evaluated.ResultsAll patients underwent ISF-TEVAR with LSA fenestration, and there was no recurrence during the follow-up. The mean length of the branch stent extension was 10.37 ± 0.34 mm, which was used to divide the patients into long and short groups. Asymptomatic hemodynamic changes (defined as a 20 mmHg interbrachial systolic pressure difference) in LSA were observed in 61 patients undergoing ISF-TEVAR involving LSA fenestration. The Spearman correlation analysis showed extension length of a branch stent >1.5 cm elevated the risk of hemodynamic changes.ConclusionOverall, we conclude that branch stent extension length >1.5 cm induced LSA hemodynamic changes. Appropriate shortening of the stent extension length can improve the curative effect of ISF-TEVAR, especially when faced with a type II/III aortic arch and stent angles of <30 degrees.

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Mechanical Behaviour of Fenestrations in Current Aortic Endografts

Cited by 3 publications

References 16 publications

Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations

Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations

Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations—An In Vitro Study

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

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