Belczak Sergio Q, Lanzaiotti Luiz, Botelho Yuri, Aun Ricardo, Silva Erasmo S da, Puech-Leão Pedro, Luccia Nelson de
Department of Vascular Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo/, SP, Brazil.
Clinics (Sao Paulo). 2015 Jun;70(6):435-40. doi: 10.6061/clinics/2015(06)09. Epub 2015 Jun 1.
To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft.
A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50-60 kg to assess the new endograft model.
The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility.
The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms.
分析近肾动脉瘤的血管造影参数，以评估一种血管内移植物模型对患者的适用性，并创建体外和体内模型来评估新型血管内移植物。
对49例近肾动脉瘤患者进行血管造影评估，分析诸如主动脉直径、瘤颈长度、腹腔干、肠系膜上动脉和肾动脉的角度；它们之间的距离；以及解剖变异等参数。基于这些参数，开发了一种血管内移植物模型，并在新创建的近肾动脉瘤体外模型中进行测试。然后在6只体重50 - 60千克的猪身上建立近肾动脉瘤实验模型，以评估新型血管内移植物模型。
本研究中测量的近肾动脉瘤血管造影参数与文献报道的相似，基于沙漏概念开发的血管内移植物适用于85.8%的患者。近肾动脉瘤体外模型显示出良好的造影显影性和功能性，并允许对新装置进行调整以及改进治疗这些动脉瘤的手术技术。此外，使用牛心包补片在所有6只动物中成功创建了近肾动脉瘤猪模型，在三个试点手术中使用新型血管内移植物证明了其可行性。
沙漏型血管内移植物仅通过改变其直径就适用于大多数近肾动脉瘤患者的治疗。此外，新的体外和体内模型被证明对于评估所展示的血管内移植物以及评估近肾动脉瘤血管内治疗的实验均有效。
