Treatment of type II endoleaks with a novel polyurethane thrombogenic foam: Induction of endoleak thrombosis and elimination of intra-aneurysmal pressure.

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Presentation transcript:

Treatment of type II endoleaks with a novel polyurethane thrombogenic foam: Induction of endoleak thrombosis and elimination of intra-aneurysmal pressure in the canine model Jason Y. Rhee, BA, Susan M. Trocciola, MD, Rajeev Dayal, MD, Stephanie Lin, MD, Rabih Chaer, MD, Naveen Kumar, MD, Albeir Mousa, MD, Joshua Bernheim, MD, Paul Christos, MPH, MS, Martin Prince, MD, Michael L. Marin, MD, Ronald Gordon, MD, Juan Badimon, PhD, Valentin Fuster, MD, PhD, K. Craig Kent, MD, Peter L. Faries, MD Journal of Vascular Surgery Volume 42, Issue 2, Pages 321-328 (August 2005) DOI: 10.1016/j.jvs.2005.04.043 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 Schematic diagram of retrograde (type II) endoleak treatment. A, The prosthetic aneurysm (A) is sewn as an interposition graft in the infrarenal aorta. Paired lumbar arteries are reimplanted onto the aneurysm as a Carrel patch. The strain-gauge pressure transducer (T) enables intra-aneurysmal pressure determination. B, The retrograde (type II) endoleak is created by deploying a stent graft (SG) coaxially through the aneurysm to exclude it from antegrade perfusion. C, Polyurethane foam (PUF) is implanted into the aneurysm sac at the same setting once the distal end of the SG has been deployed through the endovascular graft (EVG) catheter. The PUF delivery catheter is positioned within the aneurysm sac before deployment of the stent graft and is withdrawn after deployment. Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 A, Intraoperative photograph of aneurysm creation. The lumbar arteries (yellow arrow) have been anastomosed to the posterior aspect of the prosthetic aneurysm by using a Carrel patch. The pressure-transducer cable can be seen exiting the anterior aspect of the aneurysm. B, Coronal magnetic resonance angiogram before aneurysm exclusion. Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 Polyurethane foam implant (Biomerix, Rockville, Md) and delivery system. The self-expanding polyurethane foam is extruded from the delivery catheter. The delivery system is composed of coaxially placed catheters and push rods. Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 4 Intraoperative angiography during polyurethane foam (PUF) implantation. A, Intraoperative angiogram demonstrating placement of a PUF implant-loaded catheter (small white arrow) via the contralateral femoral artery. Note the patent lumbar arteries (black arrows). The PUF may be visualized as filling defects within the aneurysm sac (large white arrows). B, Completion angiogram demonstrating complete exclusion of the aneurysm without retrograde flow from implanted lumbar arteries. Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 5 Gross specimen of polyurethane foam (PUF)-treated aneurysm with the endovascular stent graft removed. Note the presence of thrombus amid the PUF in the aneurysm sac. Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 6 Comparison of intra-aneurysmal pressures. Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 7 Photomicrograph of polyurethane foam (PUF)-treated aneurysm. A, Thrombus within PUF (black arrow) inside of a prosthetic aneurysm (magnification, ×40; stain, hematoxylin and eosin). B, Higher magnification illustrating incorporation of thrombus with red blood cells, red blood cell fragments, fibrin, and occasional white blood cells within PUF (magnification, ×100; stain, hematoxylin and eosin). Journal of Vascular Surgery 2005 42, 321-328DOI: (10.1016/j.jvs.2005.04.043) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions