Mestres Gaspar, Yugueros Xavier, Apodaka Ana, Urrea Rodrigo, Pasquadibisceglie Savino, Alomar Xavier, Riambau Vincent
Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
J Vasc Surg. 2017 Oct;66(4):1227-1235. doi: 10.1016/j.jvs.2016.09.046. Epub 2017 Jun 26.
The aim of this study is to identify which endograft-parallel stent combinations and which degree of oversizing result in the most adequate fit in a juxtarenal abdominal aneurysmal neck, when using a double or triple parallel-stent (chimney) technique.
In vitro silicon, juxtarenal, abdominal aortic aneurysmal neck models of different diameters, with two and three side-branches (simulating both the renal and superior mesenteric arteries), were constructed. Two different endografts of three diameters each, with two or three parallel stents (of 6 mm and 6 mm; or 6 mm, 6 mm, and 8 mm) were tested (Endurant-II endograft [Medtronic Inc, Santa Rosa, Calif] with balloon-expandable BeGraft stent [Bentley InnoMed, Hechingen, Germany] and an Excluder endograft [W. L. Gore and Associates, Flagstaff, Ariz] with self-expanding Viabahn stent [W. L. Gore and Associates]), applying three endograft-oversizing degrees: recommended (15%), excessive (30%), and over-excessive (40%). After remodeling, using the kissing-balloon technique at 37°C (98.6°F), 36 endograft-stent-oversizing models were scanned by computed tomography. The area of the gutters, parallel-stent compression, and main endograft infolding were recorded.
Increasing oversizing (15%, 30%, and 40%) revealed a nonsignificant propensity toward smaller gutters and similar parallel-stent compression, but it significantly augmented infolding, more in three parallel-stent models (0%, 0%, 67% and 0%, 33%, 83% of cases; P = .015 and .018, for two and three parallel-stent models; n = 36) and mainly for the Excluder-Viabahn combination. The Excluder-Viabahn showed significantly smaller gutters, but with higher stent compression, than Endurant-BeGraft combinations for both two and three parallel stents (8.2 mm, 22.6 mm; P = .002 and 14.4 mm, 23.3 mm; P = .009 gutter area; and 18%, 2%; P < .001 and 15%, 2%; P = .007 relative stent area compression, respectively).
Better endograft stent apposition was usually attained when using 30% oversizing during two and three parallel-stent techniques. Higher oversizing was related to nonsignificant smaller gutters but higher rates of infolding. Smaller gutters, but higher stent compression and risk of infolding, were achieved with the Excluder-Viabahn than with the Endurant-BeGraft combination.
本研究旨在确定在使用双平行支架或三平行支架（烟囱）技术时，哪种血管内移植物与平行支架的组合以及何种尺寸过大程度能使肾旁腹主动脉瘤颈部达到最理想的贴合度。
构建了不同直径的体外硅质肾旁腹主动脉瘤颈部模型，带有两个和三个侧支（模拟肾动脉和肠系膜上动脉）。测试了两种不同直径的三种血管内移植物，分别搭配两个或三个平行支架（6毫米和6毫米；或6毫米、6毫米和8毫米）（美敦力公司的Endurant-II血管内移植物与球囊扩张式BeGraft支架[德国黑兴根的本特利创新医疗公司]，以及WL戈尔公司的Excluder血管内移植物与自膨式Viabahn支架[WL戈尔公司]），应用三种血管内移植物尺寸过大程度：推荐值（15%）、过大（30%）和过度过大（40%）。在37°C（98.6°F）下采用吻合法球囊技术进行重塑后，通过计算机断层扫描对36个血管内移植物-支架-尺寸过大模型进行扫描。记录了间隙面积、平行支架压缩情况和主要血管内移植物折叠情况。
尺寸过大程度增加（15%、30%和40%）显示间隙变小的倾向不显著，平行支架压缩情况相似，但折叠情况显著增加，在三平行支架模型中更明显（两种和三平行支架模型的病例分别为0%、0%、67%和0%、33%、83%；P = 0.015和0.018；n = 36），且主要针对Excluder-Viabahn组合。对于双平行支架和三平行支架，Excluder-Viabahn组合的间隙明显更小，但支架压缩程度更高，与Endurant-BeGraft组合相比（间隙面积分别为8.2毫米、22.6毫米；P = 0.002和14.4毫米、23.3毫米；P = 0.009；相对支架面积压缩分别为18%、2%；P < 0.001和15%、2%；P = 0.007）。
在双平行支架和三平行支架技术中，通常采用30%的尺寸过大程度可实现更好的血管内移植物与支架贴合。尺寸过大程度更高与间隙变小不显著但折叠率更高有关。与Endurant-BeGraft组合相比，Excluder-Viabahn组合间隙更小，但支架压缩程度更高且有更高的折叠风险。
