Evaluation of pressure transmission and intra-aneurysmal contents after endovascular repair using the Trivascular Enovus expanded polytetrafluoroethylene.

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Presentation transcript:

Evaluation of pressure transmission and intra-aneurysmal contents after endovascular repair using the Trivascular Enovus expanded polytetrafluoroethylene stent graft in a canine model of abdominal aortic aneurysm Robert L. Hynecek, MD, Mikel Sadek, MD, Brian G. DeRubertis, MD, Evan J. Ryer, MD, Jason Choi, BA, Steven Hsu, BA, K. Craig Kent, MD, Peter L. Faries, MD Journal of Vascular Surgery Volume 46, Issue 5, Pages 1005-1013 (November 2007) DOI: 10.1016/j.jvs.2007.06.041 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 A photograph of a deployed Enovus stent graft highlights characteristics of its construction. The low-permeability expanded polytetrafluoroethylene graft body (GB) is bounded on either extremity by barbed nitinol bare stents (BS), with a covered stent (CS) component located more proximally. A series of circular channels (*) are filled with epoxy during graft deployment. Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 Intraoperative photographs are oriented with the proximal aorta on the left of the image. A, The infrarenal abdominal aorta is exposed from the renal arteries to the trifurcation. B, The prosthetic aneurysm (AAA) with an intraluminal transducer (T) is placed as an interposition graft in the infrarenal aorta. The inferior vena cava (IVC) is visible adjacent to the abdominal aorta. Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 A, Intraoperative angiography illustrates the prosthetic aneurysm (AAA) and incorporated transducer (T). B, Component epoxy can be visualized as radiopaque rings, which demarcate the body of the Enovus graft (SG) between the proximal and distal nitinol stents. C, Completion angiography confirms aneurysm exclusion and the absence of endoleak. Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 Once explanted, the prosthetic aneurysm sac was divided longitudinally, and the Enovus stent graft (SG) was separated from the aorta to evaluate aneurysm sac contents (SC) and aid in visualization of the graft. Suture lines reveal each end-to-end anastomosis (A) connecting the prosthetic aneurysm sac to the native aorta. Excellent apposition of the stent graft to the native arterial wall can be demonstrated by the impression left by the covered stent on the luminal surface of the aorta (*). Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 Mean arterial pressure (MAP; black) and pulse pressure (gray) tracings were collected during surgery from a transducer located in the aneurysm sac. After the insertion (A) and deployment (B) of the stent graft, pulse pressure was extinguished, but MAP persisted. Pulse pressure artifacts can be seen as intermittent spikes throughout the procedure. Epoxy was injected to solidify the stent between intervals B and C. Inconsistency in the MAP signal is evident during balloon fixation of the distal and proximal stents (D and E). An exponential MAP decay is apparent shortly after abdominal closure (F). Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 6 A highly conserved pattern of exponential mean arterial pressure decay was witnessed only in aneurysm sacs excluded with the Enovus stent graft. An exponential regression for the 20-minute mean pressure decay interval has a coefficient of determination (R2) equal to 0.989. Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 7 Surveillance computed tomographic angiograms were conducted during the postoperative period to evaluate stent-graft position and search for evidence of endoleak. A representative axial image demonstrates intravenous contrast within the stent graft (SG) without radiologic evidence of leak into the aneurysm sac (AAA). Radiodensity ventral to the AAA represents the transducer cable (T). Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 8 Photomicrographs of aneurysm sac contents were obtained 4 weeks after aneurysm exclusion with the Enovus stent graft. A, Hematoxylin and eosin (original magnification, 20×) demonstrates a preponderance of red blood cells with rare fibrillar material (F). B, Masson trichrome stain (original magnification, 20×) of a similar section shows no mature collagen deposition within the field. Journal of Vascular Surgery 2007 46, 1005-1013DOI: (10.1016/j.jvs.2007.06.041) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions