Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, 310003, China.
Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, 310003, China.
Eur J Vasc Endovasc Surg. 2024 May;67(5):819-826. doi: 10.1016/j.ejvs.2023.08.060. Epub 2023 Aug 26.
In this study, the long term durability of fenestrations after in situ fenestration (ISF) of five commercial thoracic aortic stent grafts was evaluated in an in vitro experiment after a simulated 10 year period.
Five different thoracic aortic stent grafts (Relay, Valiant, Hercules, TAG, and Ankura, with a diameter of 34 mm) received both needle and laser ISF in vitro. A Viabahn (11 × 50 mm) was released in each fenestration as a bridging stent graft. Long term fatigue tests (simulating 10 years) of each of the fenestrated stent grafts were then conducted in a flow fatigue test system. The area, shape, margin, and the long and short axis of all the fenestrations were evaluated with light microscopy before and after the fatigue test. The leakage from the fenestration junction before and after the long term fatigue was also measured.
The experimental results showed no obvious difference between needle and laser fenestrations. The long axes of all the fenestrations remained unchanged, while the short axes increased after the fatigue test, which was significant in Relay, Valiant, and Hercules polyethylene terephthalate stent grafts. The shape scores of fenestrations improved after the fatigue test in Valiant and Hercules, remained unchanged in Relay and Ankura, and worsened in the TAG. After the fatigue cycling, the average leakage from the fenestration junction decreased in all the stent grafts, and the Ankura had the maximum decline rate.
The ISF technique was durable over a simulated 10 year period. The fenestrations were positively remodelled to be more circular, and the leakage from the junction decreased after long term fatigue testing.
本研究通过体外模拟 10 年的实验，评估了 5 种商业胸主动脉支架移植物原位开窗（ISF）后开窗的长期耐久性。
体外对 5 种不同的胸主动脉支架移植物（Relay、Valiant、Hercules、TAG 和 Ankura，直径 34mm）进行了针式和激光 ISF。每个开窗内释放了一个 Viabahn（11×50mm）作为桥接支架移植物。然后在流量疲劳测试系统中对每个开窗的支架移植物进行长期疲劳测试（模拟 10 年）。在疲劳测试前后，用光学显微镜评估所有开窗的面积、形状、边缘以及长轴和短轴。还测量了长期疲劳前后开窗交界处的渗漏情况。
实验结果表明，针式和激光开窗无明显差异。所有开窗的长轴在疲劳测试后保持不变，而短轴增加，在 Relay、Valiant 和 Hercules 聚对苯二甲酸乙二醇酯支架移植物中更为明显。Valiant 和 Hercules 开窗的形状评分在疲劳测试后有所改善，Relay 和 Ankura 不变，TAG 恶化。经过疲劳循环后，所有支架移植物的开窗交界处的平均渗漏量均有所减少，Ankura 的下降率最大。
ISF 技术在模拟的 10 年内是耐用的。经过长期疲劳测试后，开窗处积极地重塑为更圆的形状，交界处的渗漏减少。
