Rouer Martin, Meilhac Olivier, Delbosc Sandrine, Louedec Liliane, Pavon-Djavid Graciela, Cross Jane, Legagneux Josette, Bouilliant-Linet Maxime, Michel Jean-Baptiste, Alsac Jean-Marc
INSERM U698 Cardiovascular Remodelling, Hôpital X. Bichat, AP-HP, Paris.
J Vis Exp. 2013 Jul 7(77):e50740. doi: 10.3791/50740.
Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 1990(1) in a rat, then described in mice(2). Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.
血管内动脉瘤隔绝术是一种经证实可预防动脉瘤破裂的技术。长期结果凸显了该技术的局限性以及腹主动脉瘤（AAA）病理生理学的新方面。目前尚无廉价且可重复的腹主动脉瘤腔内隔绝模型，而这种模型有助于对AAA治疗前后进行深入研究。在此，我们描述如何在大鼠中诱导腹主动脉瘤，然后使用带膜冠状动脉支架移植物对其进行隔绝。著名的弹性蛋白酶诱导的AAA模型于1990年首次在大鼠中报道（1），随后在小鼠中也有描述（2）。弹性蛋白降解导致主动脉扩张，伴有腹壁炎性浸润和腔内血栓形成，与人类AAA相符。然后使用小型带膜支架移植物进行血管内隔绝，排除循环血液与动脉瘤血栓之间的任何相互作用。在安乐死之前，通过经左颈动脉的血管造影确认适当的隔绝和支架移植物通畅情况。弹性蛋白酶扩散的部分控制使得每只动物的动脉瘤形状不同。很难制造出一种动脉瘤，既能在动脉瘤下方留出足够长度的主动脉以便轻松引入支架移植物，又能有足够的近端和远端颈部以防止内漏。支架移植物的引入可能会导致许多失败情况，有时会导致主动脉撕裂并伴有疼痛以及缝合困难，还会造成内皮损伤并伴有术后主动脉血栓形成。在植入支架移植物前给大鼠服用阿司匹林可降低失败率且无大出血情况。夹闭时间会激活中性粒细胞、内皮细胞和血小板，可能会干扰生物学分析。
