Document Detail

In Vitro Analysis of Type II Endoleaks and Aneurysm Sac Pressurization on Longitudinal Stent-Graft Displacement.
MedLine Citation:
PMID:  21861753     Owner:  NLM     Status:  In-Data-Review    
Abstract Purpose: To evaluate the effects of type II endoleaks and sac pressurization on stent-graft displacement following endovascular aneurysm repair (EVAR). Methods: Experimental silicone infrarenal aneurysm (6-cm) models were "treated" with a Talent stent-graft deployed with 20-mm proximal and distal landing zones. Inflow and outflow vessels were created as part of the silicone model to control flow into the aneurysm sac. All aneurysm models were uniform, with a diameter neck of 31 mm, a neck length of 20 mm, and iliac artery diameters of 16 mm. The aortic model was secured in a water bath to a pulsatile pump under physiological conditions; the output phase ratio (%systole/%diastole) was set at 65/35 with a pump rate of 80 beats per minute. Commercially available bifurcated stent-grafts were then displaced in vitro utilizing a linear motion apparatus attached to a force gauge. The mean arterial pressure (MAP) and pulse pressure (PP) at the aortic inflow were 60.1±3.1 and 38.3±7.8 mmHg, respectively. Peak force to cause initial stent-graft migration with and without a type II endoleak was recorded and compared. Results: In aneurysm sacs with no endoleak, the MAP and sac PP were 32±6.4 and 6±1.3 mmHg, respectively (p<0.01). In aneurysm sacs with a type II endoleak, the MAP and sac PP were 54.1±9.7 and 16.1±4.1 mmHg, respectively (p<0.02). Peak force to initiate migration was 16.0±1.41 N (range 15-18) with no endoleak vs. 23.2±2.2 N (range 20-25) in those with a type IIa endoleak and 23.5±2.5 N (range 20-26) in those with a type IIb endoleak (p<0.001). Conclusion: Type II endoleaks are associated with a significantly increased sac pressure. Increased sac pressurization from type II endoleaks results in a significantly greater force to displace a stent-graft longitudinally. Type II endoleaks may therefore inhibit migration and offer a benefit following EVAR; however, clinical correlation of these results is required.
Martyn Knowles; Tiago Pellisar; Erin H Murphy; Gregory A Stanley; Abraham F Hashmi; M Zachary Arko; Frank R Arko
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  18     ISSN:  1545-1550     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  601-6     Citation Subset:  IM    
Department of Vascular and Endovascular Surgery, University of Texas-Southwestern, Dallas, Texas, USA.
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