The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene.

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Presentation transcript:

The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene stent-grafts: Characterization using a canine model Susan M. Trocciola, MD, Rajeev Dayal, MD, Rabih A. Chaer, MD, Stephanie C. Lin, MD, Brian DeRubertis, MD, Evan J. Ryer, MD, Robert L. Hynececk, MD, Matthew J. Pierce, BA, Martin Prince, MD, PhD, Juan Badimon, PhD, Michael L. Marin, MD, Valentin Fuster, MD, PhD, K. Craig Kent, MD, Peter L. Faries, MD Journal of Vascular Surgery Volume 43, Issue 1, Pages 109-116 (January 2006) DOI: 10.1016/j.jvs.2005.09.023 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 An expanded polytetrafluoroethylene aneurysm with an implanted pressure transducer. The transducer cable is tunneled through the abdominal wall and tracked subcutaneously toward the dorsal aspect of the animal. The metal connector exits the interscapular skin, caudal to the neck. This allows continuous intra-aneurysmal pressure measurement. Journal of Vascular Surgery 2006 43, 109-116DOI: (10.1016/j.jvs.2005.09.023) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 The appearance of a prosthetic infrarenal aneurysm (AAA) in situ. The cable of the pressure transducer (Tr) is seen at the right side of the image as it exits the wall of the aneurysm. Trifurcation is beyond the distal aspect (D) of the aorta shown in the photo. Journal of Vascular Surgery 2006 43, 109-116DOI: (10.1016/j.jvs.2005.09.023) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Schematic illustration of prosthetic aneurysm. A, Dilated segment of polytetrafluoroethylene (PTFE) is inserted as an interposition graft within the transected infrarenal aorta to create an abdominal aortic aneurysm (AAA). A strain-gauge pressure transducer (Tr) allows intra-aneurysmal pressure determination. B, The aneurysm is excluded with a PTFE or Dacron stent-graft (SG). Journal of Vascular Surgery 2006 43, 109-116DOI: (10.1016/j.jvs.2005.09.023) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Intraoperative angiography used during endovascular exclusion of aneurysms. A, An angiogram demonstrates the prosthetic aneurysm (AAA) with an indwelling strain-gauge transducer (Tr). B, Digital-subtraction angiogram demonstrates the use of an endoluminal aortic stent-graft (SG) to exclude the same aneurysm. Journal of Vascular Surgery 2006 43, 109-116DOI: (10.1016/j.jvs.2005.09.023) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 A, Magnetic resonance angiography with gadolinium demonstrates aneurysm (AAA) after endovascular exclusion with a stent-graft (SG). B, T1-weighted magnetic resonance axial image demonstrates acquisition of signal intensity (S:N) from the AAA sac. The area of high intensity represents the lumen of the stent-graft. C, Schematic of the magnetic resonance axial image demonstrates the stent-graft (SG) and the aneurysm sac (AAA) with pressure transducer (TR) exiting from the aneurysm sac. Journal of Vascular Surgery 2006 43, 109-116DOI: (10.1016/j.jvs.2005.09.023) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 6 Comparison of histology of aneurysm sacs removed from canines with prosthetic aneurysms 4 weeks after endovascular treatment with either expanded polytetrafluoroethylene (ePTFE) or Dacron stent-grafts. Throughout pictures, T represents thrombus, G represents prosthetic aneurysm; Fib, fibrin, and Col, collagen. A, Hematoxylin and eosin staining of tissue demonstrates overview of the histology of aneurysm sac contents and prosthetic aneurysm sac wall 4 weeks after exclusion with a Dacron stent-graft (×4). B, Masson’s trichrome staining for collagen (arrow) demonstrates chronic thrombus in abdominal aortic aneurysm (AAA) sac after exclusion by a Dacron stent-graft (×40). C, Masson’s trichrome staining for collagen demonstrates lack of collagen, indicated by absence of blue labeling in AAA sac after exclusion by an ePTFE stent-graft (×10). D, Mallory’s phosphotungstic acid hematoxylin staining (PTAH) for fibrin of aneurysm sac and contents demonstrates well-organized fibrin in thrombus of AAA sac after exclusion by a Dacron stent-graft (×20). PTAH staining for fibrin demonstrates disorganized, limited fibrin in thrombus of an AAA sac after exclusion by a Dacron stent-graft (×10). Journal of Vascular Surgery 2006 43, 109-116DOI: (10.1016/j.jvs.2005.09.023) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions