The effect of injectable biocompatible elastomer (PDMS) on the strength of the proximal fixation of endovascular aneurysm repair grafts: An in vitro study

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Presentation transcript:

The effect of injectable biocompatible elastomer (PDMS) on the strength of the proximal fixation of endovascular aneurysm repair grafts: An in vitro study Willem-Maarten P.F. Bosman, MD, Tim J. van der Steenhoven, MD, Daniel R. Suárez, MSc, Edward R. Valstar, MSc, PhD, Alexander C. de Vries, MD, PhD, Hans L.F. Brom, MD, PhD, Michael J. Jacobs, MD, PhD, Jaap F. Hamming, MD, PhD Journal of Vascular Surgery Volume 52, Issue 1, Pages 152-158 (July 2010) DOI: 10.1016/j.jvs.2010.01.026 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig. 1 Aortic Customize, the treatment concept. Left side depicts the stand-alone therapy (A-F), while the right side depicts the therapy as adjuvance to current EVAR-therapy (G-L). Guide wires are inserted to the aneurysm (B), over which endovascular balloons are inserted to exclude the aneurysm sac from the circulation (C). A fill catheter was inserted next to the balloon, through which the liquid elastomer is injected (D). The elastomer fills every cavity in the aneurysm sac and obliterates lumbar arteries, thereby preventing potential endoleaks (E). When the elastomer has cured (<5 minutes), the endovascular balloon is deflated, leaving the aneurysm excluded with a new lumen (F). As adjuvant therapy (G-I), the process is very similar, whereby the cavities between the graft in an aneurysm sac are filled with the elastomer (J, K), fixating the graft in an elastomer mould of the sac. Journal of Vascular Surgery 2010 52, 152-158DOI: (10.1016/j.jvs.2010.01.026) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig. 2 Schematic drawing of experimental set-up: (A) Sample of bovine artery (45 mm long). (B) Distal fixation plug on which the bovine artery is attached. (C) Artificial aneurysm made of latex (neck 19 mm; widest part 40 mm), which is sutured to the bovine artery (D) A stent-graft inserted in the bovine neck of the aneurysm. (E) Rigid rod with anchor through the endograft, connecting it to the tensile testing machine. (F) Plugs for fixation of the set-up on tensile testing machine. Journal of Vascular Surgery 2010 52, 152-158DOI: (10.1016/j.jvs.2010.01.026) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig. 3 The endoprotheses used in this study: (A) Gore Excluder, (B) Vascutek Anaconda, and (C) Medtronic Endurant. Journal of Vascular Surgery 2010 52, 152-158DOI: (10.1016/j.jvs.2010.01.026) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig. 4 The dislodgement forces (DF) for the different kinds of stent grafts. The bars show mean dislodgement force (n = 5) for the seal length, while the error bars depict the standard deviation (SD). The empty bars show the force needed to dislodge the graft when the aneurysm sac was empty; the striped bars show the forces needed after filling the sac with elastomer. The graph at the right shows that all grafts benefit from the elastomer augmentation. Journal of Vascular Surgery 2010 52, 152-158DOI: (10.1016/j.jvs.2010.01.026) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig. 5 Overview of the setup, the specimens, the grafts, and the elastomer. Inset A shows the setup with a bovine artery with the sutured latex aneurysm. In the artery, a Gore Excluder is placed, which is fixated by elastomer sac-filling. On the top of inset A, the rigid hook is visible on which the graft is attached. The elastomer filling has taken on the exact form of the latex aneurysm with the graft in place (B, E). When the endograft is removed from the elastomer mould, it becomes clear that the elastomer had filled every cavity between graft and sac, leaving casts of the struts of the graft (C). The sharp, rigid hooks for proximal fixation of the Anaconda left distinctive damage to aortic wall, when applying high extraction forces (D). Journal of Vascular Surgery 2010 52, 152-158DOI: (10.1016/j.jvs.2010.01.026) Copyright © 2010 Society for Vascular Surgery Terms and Conditions