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The impact of stent design on proximal stent-graft fixation in the abdominal aorta: an experimental study

Resch, Tim LU ; Malina, Martin LU ; Lindblad, Bengt LU ; Malina, J; Brunkwall, J and Ivancev, Krassi LU (2000) In European Journal of Vascular and Endovascular Surgery 20(2). p.190-195
Abstract
OBJECTIVE: to study the proximal fixation of different aortic stent grafts in comparison to a hand-sewn anastomosis. DESIGN: experimental study. MATERIAL: the infrarenal aorta of 16 human cadavers were exposed, left in situ and transected 3 cm above the aortic bifurcation to mimic an infrarenal aortic neck. Stent grafts were deployed through a sheath 5 cm into the aorta. Ancure, Talent, Vanguard, Zenith and a Palmaz based stent graft were assessed. In addition a polyester graft was anastomosed to the aorta by running sutures. Distal force was applied to the grafts in increments of 0.5 Newton until the stent grafts were completely dislodged from the aorta. The displacement force (DF) was thereby determined. RESULTS: a force of 150 N... (More)
OBJECTIVE: to study the proximal fixation of different aortic stent grafts in comparison to a hand-sewn anastomosis. DESIGN: experimental study. MATERIAL: the infrarenal aorta of 16 human cadavers were exposed, left in situ and transected 3 cm above the aortic bifurcation to mimic an infrarenal aortic neck. Stent grafts were deployed through a sheath 5 cm into the aorta. Ancure, Talent, Vanguard, Zenith and a Palmaz based stent graft were assessed. In addition a polyester graft was anastomosed to the aorta by running sutures. Distal force was applied to the grafts in increments of 0.5 Newton until the stent grafts were completely dislodged from the aorta. The displacement force (DF) was thereby determined. RESULTS: a force of 150 N (140-160) applied to the hand-sewn graft resulted in tearing of the aorta, without breakage of the sutures. The median displacement force was for Talent 4.5 N (1.3-5.5), Vanguard 9.0 N (3. 5-12), Ancure 12.5 N (12-14), Zenith 24 N (23-26.5) and Palmaz 25 N (17-25). Ballooning the stent after deployment improved fixation in some cases. CONCLUSIONS: a sutured anastomosis fixates a graft better than any stent design tested. Hooks and barbs improve the fixation of self-expandable stents. Balloon dilatation of the proximal stent after deployment might increase fixation further. Balloon expandable stents seem to provide good fixation without the use of hooks and barbs. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Stent grafts, Fixation, Migration, Aortic aneurysm, Therapy
in
European Journal of Vascular and Endovascular Surgery
volume
20
issue
2
pages
190 - 195
publisher
Elsevier
external identifiers
  • pmid:10942692
  • scopus:0033845597
ISSN
1532-2165
DOI
10.1053/ejvs.1999.0991
language
English
LU publication?
yes
id
7a348403-1302-4ffd-802c-a386817b8067 (old id 1116473)
date added to LUP
2008-07-01 13:34:01
date last changed
2017-06-11 04:24:32
@article{7a348403-1302-4ffd-802c-a386817b8067,
  abstract     = {OBJECTIVE: to study the proximal fixation of different aortic stent grafts in comparison to a hand-sewn anastomosis. DESIGN: experimental study. MATERIAL: the infrarenal aorta of 16 human cadavers were exposed, left in situ and transected 3 cm above the aortic bifurcation to mimic an infrarenal aortic neck. Stent grafts were deployed through a sheath 5 cm into the aorta. Ancure, Talent, Vanguard, Zenith and a Palmaz based stent graft were assessed. In addition a polyester graft was anastomosed to the aorta by running sutures. Distal force was applied to the grafts in increments of 0.5 Newton until the stent grafts were completely dislodged from the aorta. The displacement force (DF) was thereby determined. RESULTS: a force of 150 N (140-160) applied to the hand-sewn graft resulted in tearing of the aorta, without breakage of the sutures. The median displacement force was for Talent 4.5 N (1.3-5.5), Vanguard 9.0 N (3. 5-12), Ancure 12.5 N (12-14), Zenith 24 N (23-26.5) and Palmaz 25 N (17-25). Ballooning the stent after deployment improved fixation in some cases. CONCLUSIONS: a sutured anastomosis fixates a graft better than any stent design tested. Hooks and barbs improve the fixation of self-expandable stents. Balloon dilatation of the proximal stent after deployment might increase fixation further. Balloon expandable stents seem to provide good fixation without the use of hooks and barbs.},
  author       = {Resch, Tim and Malina, Martin and Lindblad, Bengt and Malina, J and Brunkwall, J and Ivancev, Krassi},
  issn         = {1532-2165},
  keyword      = {Stent grafts,Fixation,Migration,Aortic aneurysm,Therapy},
  language     = {eng},
  number       = {2},
  pages        = {190--195},
  publisher    = {Elsevier},
  series       = {European Journal of Vascular and Endovascular Surgery},
  title        = {The impact of stent design on proximal stent-graft fixation in the abdominal aorta: an experimental study},
  url          = {http://dx.doi.org/10.1053/ejvs.1999.0991},
  volume       = {20},
  year         = {2000},
}