Lin Jing, Guan Xiaoning, Nutley Mark, Panneton Jean M, Zhang Ze, Guidoin Robert, Wang Lu
Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.
Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China.
Materials (Basel). 2023 Jul 9;16(14):4913. doi: 10.3390/ma16144913.
In situ fenestration of endovascular stent-grafts has become a mainstream bailout technique to treat complex emergent aneurysms while maintaining native anatomical visceral and aortic arch blood supplies. Fabric tearing from creating the in situ fenestration using balloon angioplasty may extend beyond the intended diameter over time. Further tearing may result from the physiologic pulsatile motion at the branching site. A resultant endoleak at the fenestrated sites in stent-grafts could ultimately lead to re-pressurization of the aortic sac and, eventually, rupture. In an attempt to address this challenge, plain woven fabrics were designed. They hold a specific corona surrounding a square-shaped cluster with a plain weave fabric structure, a 2/2 twill, or a honeycomb. The corona was designed to stop potential further tearing of the fabric caused by the initial balloon angioplasty and stent or later post-implantation motion. The cluster within the corona was designed with relatively loose fabric structures (plain weave, 2/2 twill weave, and honeycomb) to facilitate the laser fenestration. Two commercial devices, Anaconda (Vascutek, Terumo Aortic) and Zenith TX2 (Cook), were selected as controls for comparison against this new design. All the specimens were characterized by morphology, thickness, and water permeability. The results demonstrated that all specimens with a low thickness and water permeability satisfied the requirements for a stent graft material that would be low profile and resistant to endoleaks. The in situ fenestrations were performed on all fabrics utilizing an Excimer laser followed by balloon angioplasty. The fabrics were further observed by light microscopy and scanning electron microscopy. The dimension of the fenestrated apertures was smaller than the balloon's diameter. The tearing was effectively confined within the corona. The clinical acceptability of this concept deserves additional bench testing and animal experimentation.
血管内支架移植物原位开窗术已成为治疗复杂急诊动脉瘤的主流补救技术，同时可维持天然解剖结构的内脏和主动脉弓血供。使用球囊血管成形术进行原位开窗时造成的织物撕裂可能会随着时间推移超出预期直径。分支部位的生理性搏动运动可能导致进一步撕裂。支架移植物开窗部位产生的内漏最终可能导致主动脉瘤囊重新受压，最终破裂。为应对这一挑战，设计了平纹织物。它们具有围绕方形簇的特定冠状结构，采用平纹织物结构、2/2斜纹或蜂窝状结构。冠状结构旨在阻止最初的球囊血管成形术和支架或植入后运动导致织物进一步撕裂。冠状结构内的簇采用相对宽松的织物结构（平纹、2/2斜纹和蜂窝状）设计，以利于激光开窗。选择两种商用器械Anaconda（Vascutek，Terumo Aortic）和Zenith TX2（Cook）作为对照，与这种新设计进行比较。所有标本均通过形态、厚度和透水性进行表征。结果表明，所有厚度和透水性较低的标本均满足低轮廓且抗内漏的支架移植物材料要求。对所有织物使用准分子激光进行原位开窗，随后进行球囊血管成形术。通过光学显微镜和扫描电子显微镜进一步观察织物。开窗孔的尺寸小于球囊直径。撕裂有效地局限在冠状结构内。这一概念的临床可接受性值得进一步进行台架试验和动物实验。
