Vos A W F, Linsen M A M, Wisselink W, Rauwerda J A
Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2004 May;27(5):492-7. doi: 10.1016/j.ejvs.2004.01.008.
To evaluate and refine a stent-graft system with side branches for treatment of aneurysms with essential branch arteries.
In a porcine model (n=4) supra- and juxta-renal aortic aneurysms were created by suturing an artificial patch onto an anterior aortotomy. Angiography was performed to determine the exact location of the renal arteries. Accordingly, fenestrations were created in an appropriately sized aortic stent-graft. Initial deployment of the aortic graft is partial, whereby the top stent is secured in a cap and distal stents are being restrained, thus ensuring longitudinal and rotational manoeuvrability during alignment of the branch arteries. Separate branch grafts with silicone flanges for connection with the main stent-graft are subsequently placed in the renal arteries followed by full deployment of the main stent-graft. Outcome was evaluated by postoperative angiography and autopsy results and by measuring operating time, blood loss and use of contrast agent.
Branched grafts were placed successfully in all trials. The median endovascular procedure time was 126 min (90-160), with 575 ml (400-800) blood loss and 65 ml (50-80) contrast agent use. Angiographically, all aneurysms were excluded without signs of endoleak and all renal arteries were patent. At autopsy, the main stent-graft and all side branches were adequately placed with intact connections between main stent-graft and branch grafts.
In this model, endovascular repair of complex aneurysms using a modular branch graft system is feasible in a reliable, predictable and timely fashion.
评估并改进一种带有侧支的支架型血管移植物系统，用于治疗伴有重要分支动脉的动脉瘤。
在猪模型（n = 4）中，通过将人工补片缝合到主动脉前壁切口处，制造肾上和肾周主动脉瘤。进行血管造影以确定肾动脉的确切位置。据此，在尺寸合适的主动脉支架型血管移植物上制造开窗。主动脉移植物的初始释放是部分释放，即顶部支架固定在帽状物中，远端支架受到限制，从而在分支动脉对齐过程中确保纵向和旋转的可操作性。随后将带有用于与主支架型血管移植物连接的硅胶法兰的单独分支移植物放置在肾动脉中，然后完全释放主支架型血管移植物。通过术后血管造影和尸检结果，以及测量手术时间、失血量和造影剂用量来评估结果。
在所有试验中分支移植物均成功放置。血管内手术的中位时间为126分钟（90 - 160分钟），失血量为575毫升（400 - 800毫升），造影剂用量为65毫升（50 - 80毫升）。血管造影显示，所有动脉瘤均被排除，无内漏迹象，所有肾动脉均通畅。尸检时，主支架型血管移植物和所有侧支均放置得当，主支架型血管移植物与分支移植物之间连接完整。
在该模型中，使用模块化分支移植物系统对复杂动脉瘤进行血管内修复是可行的，且可靠、可预测并及时。
