Department of Vascular Surgery, Vascular Center, Second Xiangya Hospital, Central South University, Changsha 410011.
Institute of Vascular Diseases, Central South University, Changsha 410011.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Sep 28;47(9):1227-1234. doi: 10.11817/j.issn.1672-7347.2022.220161.
To isolate aortic arch pathologies and keep the branches superior in arch patent, it always need physicians to do in-vivo fenestration or in-situ fenestration when performing the thoracic endovascular aortic repair (TEVAR). However, both of those fenestration techniques need structure modification of the stent-graft, which may affect their long-term stability. We designed an adjustable pre-fenestration aortic stent-graft to treat pathologies in this area and obtained a patent branch arteries. This study used this new designed stent-graft to perform fenestrated-TEVAR (f-TEVAR) in canine aorta. This study aims to identify its feasibility and safety through animal experiments, which might provide preliminary data for potential human implantation.
A total of 8 Labrador Retrievers were underwent f-TEVAR by using the new devices. Digital subtraction angiography was performed before and after f-TEVAR to evaluate the success of the procedures. All the canines were divided into a 4-week group (feeding for 4 weeks after operation) and a 12-week group (feeding for 12 weeks after operation). Computed tomography angiography (CTA) were performed before euthanasia.
The success rate of operation was 100%. During the operation, there was no accident of major bleeding or failure to be released by fenestration. Adjustable fenestration worked well. No stent-graft migration was found in CTA at 4 weeks and 12 weeks after the operation. All branch arteries kept by the adjustable fenestration were patent.
The result of feasibility and safety of the new designed adjustable pre-fenestration aortic stent-graft in f-TEVAR of canine is acceptable. This study provides a reference for further optimization of this stent and human f-TEVAR implantation involving aortic arch lesions.
在进行胸主动脉腔内修复术(TEVAR)时,为了保持主动脉弓分支通畅,需要医生在体内或原位进行开窗,但这两种开窗技术都需要对支架进行结构修改,可能会影响其长期稳定性。我们设计了一种可调节的预开窗主动脉支架,以治疗该部位的病变并保持分支动脉通畅。本研究使用这种新设计的支架进行犬主动脉的开窗 TEVAR(f-TEVAR),通过动物实验来验证其可行性和安全性,为潜在的人体植入提供初步数据。
共对 8 只拉布拉多犬进行 f-TEVAR,使用新装置。在 f-TEVAR 前后进行数字减影血管造影术以评估手术的成功率。所有犬分为 4 周组(术后喂养 4 周)和 12 周组(术后喂养 12 周)。在安乐死前进行计算机断层扫描血管造影(CTA)。
手术成功率为 100%。在手术过程中,没有大出血或开窗失败等重大事故。可调节的开窗工作良好。在术后 4 周和 12 周的 CTA 中,未发现支架移位。可调式开窗保留的所有分支动脉均保持通畅。
新设计的可调节预开窗主动脉支架在犬的 f-TEVAR 中的可行性和安全性结果是可以接受的。本研究为进一步优化这种支架和涉及主动脉弓病变的人体 f-TEVAR 植入提供了参考。