Arko Frank R, Heikkinen Maarit, Lee Eugene S, Bass Arie, Alsac Jean Marc, Zarins Christopher K
Division of Vascular Surgery, Stanford University Medical Center, Stanford University, CA, USA.
J Vasc Surg. 2005 Apr;41(4):664-71. doi: 10.1016/j.jvs.2004.12.050.
Migration of endovascular stent grafts has been related to the security of proximal device fixation to the aortic neck. This study evaluated the importance of iliac fixation in preventing longitudinal in vivo device displacement of a modular, externally supported stent graft.
Experimental ovine infrarenal aneurysms (n = 8) were treated with a fully supported, modular, bifurcated stent graft (AneuRx, Medtronic, Santa Rosa, Calif). Minimum iliac fixation length (1 cm) was used in four animals and iliac extender modules were used to achieve maximum iliac fixation in four animals. Suture anastomosis of bifurcated polyester grafts to the infrarenal aorta served as controls (n = 8). Aortic grafts were displaced in vivo by applying downward traction to a guidewire that was passed over the iliac flow divider and brought out both femoral arteries. The displacement force needed to initiate stent-graft migration was recorded and compared with the force needed to disrupt the sutured anastomosis.
There was no difference in animal weight (88.8 +/- 2.5 kg vs 87.5 +/- 2.9 kg), aortic neck diameter (12.7 +/- 0.9 mm vs 13.4 +/- 1.1 mm), aortic neck length (23.2 +/- 0.9 mm vs 21.8 +/- 2.4 mm), experimental aneurysm size (24.7 +/- 1.1 mm vs 24.2 +/- 2.0 mm), or iliac artery diameter (9.0 +/- 1.5 mm vs 9.3 +/- 0.5 mm) among the groups. Iliac fixation length was 31.0 +/- 0.3 mm in the maximum iliac fixation group and 11 +/- 0.25 mm in the minimum fixation group (P < .0001). Peak displacement force to initiate migration was 30.2 +/- 5.5 N (range, 25 to 38) in animals with maximum iliac fixation compared with 18.1 +/- 3.7 N (range, 13 to 21) in those with minimum fixation (P = .01). The force needed to disrupt the control surgical anastomosis was 40.6 +/- 7.5 N (range, 31 to 50) (P < .01).
Maximizing iliac fixation length increases the longitudinal in vivo force needed to displace a fully supported stent graft by 67%. This suggests that increasing iliac fixation length may reduce the long-term risk of migration in patients undergoing endovascular aneurysm repair.
血管内支架移植物的移位与近端装置固定于主动脉颈部的安全性相关。本研究评估了髂动脉固定在防止模块化、外部支撑的支架移植物在体内发生纵向装置移位方面的重要性。
用一种完全支撑的、模块化的、分叉型支架移植物（AneuRx，美敦力公司，加利福尼亚州圣罗莎）治疗实验性绵羊肾下动脉瘤（n = 8）。4只动物采用最小髂动脉固定长度（1厘米），另外4只动物使用髂动脉延长模块以实现最大髂动脉固定。将分叉型聚酯移植物与肾下主动脉进行缝合吻合作为对照（n = 8）。通过对一根穿过髂动脉分流器并引出双侧股动脉的导丝施加向下的牵引力，使主动脉移植物在体内发生移位。记录引发支架移植物移位所需的移位力，并与破坏缝合吻合所需的力进行比较。
各组动物在体重（88.8±2.5千克对87.5±2.9千克）、主动脉颈部直径（12.7±0.9毫米对13.4±1.1毫米）、主动脉颈部长度（23.2±0.9毫米对21.8±2.4毫米）、实验性动脉瘤大小（24.7±1.1毫米对24.2±2.0毫米）或髂动脉直径（9.0±1.5毫米对9.3±0.5毫米）方面均无差异。最大髂动脉固定组的髂动脉固定长度为31.0±0.3毫米，最小固定组为11±0.25毫米（P < .0001）。最大髂动脉固定的动物引发移位的峰值移位力为30.2±5.5牛（范围为25至38牛），而最小固定的动物为18.1±3.7牛（范围为13至21牛）（P = .01）。破坏对照手术吻合所需的力为40.6±7.5牛（范围为31至50牛）（P < .01）。
使髂动脉固定长度最大化可使使完全支撑的支架移植物在体内发生移位所需的纵向力增加67%。这表明增加髂动脉固定长度可能会降低接受血管内动脉瘤修复患者的长期移位风险。
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