Role of graft oversizing in the fixation strength of barbed endovascular grafts Jarin A. Kratzberg, PhD, Jafar Golzarian, MD, Madhavan L. Raghavan, PhD

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Presentation transcript:

Role of graft oversizing in the fixation strength of barbed endovascular grafts Jarin A. Kratzberg, PhD, Jafar Golzarian, MD, Madhavan L. Raghavan, PhD Journal of Vascular Surgery Volume 49, Issue 6, Pages 1543-1553 (June 2009) DOI: 10.1016/j.jvs.2009.01.069 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 Custom fabricated endovascular graft (EVG) barbs sutured to altered trunk of a commercial endovascular prosthesis. ePTFE, expanded polytetrafluoroethylene. Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Schematic of the pulsatile flow loop. Compliant tubing and pinch valves serve as compliance and resistance chambers for pulse pressure and flow control. The bypass tube helps eliminate unrealistic spiking of pressure when the flow is partially or fully obstructed during endovascular graft (EVG) deployment. AAA, abdominal aortic aneurysm. Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 Fabrication of the bio-synthetic abdominal aortic aneurysm (AAA) phantom complex. The bovine aortic neck acted as a realistic attachment site for the proximal end of the endovascular graft (EVG) while the synthetic AAA phantom allowed for realistic hemodynamics during deployment. A fresh bovine aortic neck was used for each implantation. Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 Illustration of barb penetration analysis in representative cases. Two-dimensional Maximum Intensity Projections (MIPs - a and b), cross-sectional views (c) and three dimensional rendering (d) of deployed endovascular graft (EVG) in the aorta were used for analysis. By orienting appropriately, MIPs were used to determine whether and by how much each individual barb is penetrating the aortic wall (b). Fully penetrated (FP) and not penetrated (NP) labels refer to barbs within one EVG. The zoomed barb view (b) provides graphical definitions of barb penetration depth (PD) and penetration angle (PA). Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 5 Mechanical pullout test apparatus (a) and typical load-displacement data recorded for an endovascular graft (EVG) pull-out test (b). Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 6 Relationships between graft oversizing, pullout force and the number of barbs penetrating the aortic wall. Increased graft oversizing (GO) results in decreased barb penetration (a) and pullout force (b). Poor barb penetration is clearly a factor in attachment strength (c). Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 7 Number of barbs penetrated (a) and pullout force (b) categorized by GO ranges. The box plots indicate the median (box centerline), 25th, 75th percentiles (box ends), the mean (filled diamond), and individual data points (open circles) in each group. GO, graft oversizing. Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 8 The relationship between pullout force and % penetration depth (a) and average penetration angle (b) for the endovascular grafts (EVGs) deployed. Pullout force is greater for the group with average penetration depth (PD) greater than 60% compared to the group with PD lesser than 60% (c). The box plot indicates the median (box centerline), 25th, 75th percentiles (box ends), the mean (filled diamond) and individual data points (open circles) in each group. Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 9 Illustration of the phenomenon of folding in endovascular grafts (EVGs) deployed into the aortic neck. The 3D-rendered images show five EVGs oversized greater than 30% (a-e) and one oversized by 9% (f). The stent is shown in grey/white embedded within the aortic wall shown in partly transparent red. Note the folding/collapsing apparent in EVGs with graft oversizing (GO) >30% (a-e) but not for GO = 9% (f). The location of folding – when present – is highlighted with a green circle in each image. Journal of Vascular Surgery 2009 49, 1543-1553DOI: (10.1016/j.jvs.2009.01.069) Copyright © 2009 Society for Vascular Surgery Terms and Conditions