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Ann Thorac Surg. 2014 Dec;98(6):2086-90. doi: 10.1016/j.athoracsur.2014.07.024. Epub 2014 Oct 22.

Experimental evaluation of complete endovascular arch reconstruction by in situ retrograde fenestration.

Author information

1
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; INSERM U 1046, Montpellier, France. Electronic address: ludoviccanaud@hotmail.com.
2
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; INSERM U 1046, Montpellier, France.
3
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.

Abstract

BACKGROUND:

The aim of this experimental study was to assess the feasibility of complete endovascular arch reconstruction by in situ retrograde fenestration and to investigate the impact of stent-graft material on stent-graft fenestrations.

METHODS:

The experiments were performed using 8 cadaveric human thoracic aortas (aortic arch) using 2 different stent-graft types: woven polyester (Valiant Captivia; Medtronic Vascular, Santa Rosa, CA) and expanded polytetrafluoroethylene (conformable [C]-TAG; W.L. Gore & Associates, Flagstaff, AZ). A benchtop aortic pulsatile flow model was used. Stent-grafts were deployed into the aortic arch, covering the ostia of the supraaortic trunks. A 5-mm 30-degree angioscope was introduced into the ascending aorta to monitor the procedure. Retrograde fenestration and deployment of the balloon expandable stent-graft was performed sequentially for each supraaortic trunk. Subsequent to stent-graft explantation, macroscopic evaluation of each fenestration was performed.

RESULTS:

All attempts to fenestrate the C-TAG and Valiant stent-grafts and implant the covered stent through the supraaortic trunks were successful. In all cases, branch stents were patent and no endoleak was evident. The Valiant stent-graft was easier to puncture because of the higher radial force of the stent-graft providing better counterpressure; however, stent-graft material had no impact on the quality of fenestrations.

CONCLUSIONS:

Total endovascular repair of the aortic arch through in situ retrograde fenestration of stent-grafts is feasible. The behavior of the 2 types of stent-graft was significantly different while the fenestrations were fashioned, but stent-graft material had no impact on the quality of fenestrations.

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