Iliac fixation length and resistance to in-vivo stent-graft displacement
Iliac fixation length and resistance to in-vivo stent-graft displacement
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DOI：
10.1016/j.jvs.2004.12.050
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发表时间：
2005-04-01
影响因子：
4.3
通讯作者：
Zarins, CK
中科院分区：
文献类型：
--
作者：
Arko, FR;Heikkinen, M;Zarins, CK
目的：血管内覆膜支架的移位与近端器械固定到主动脉瘤颈的安全性相关。本研究评价了髂动脉固定的重要性，在防止纵向在体内装置位移的模块化，外部支持stentgraft.Methods：实验绵羊肾下动脉瘤（n = 8）进行了治疗与完全支持，模块化，分叉支架移植物（AneuRx，美敦力，圣罗莎，加利福尼亚州）。4只动物使用最小髂动脉固定长度（1 cm），4只动物使用髂动脉延长器模块实现最大髂动脉固定。分叉聚酯移植物与肾下主动脉的缝合吻合作为对照（n = 8）。通过对穿过髂分流器并引出两条股动脉的导丝施加向下牵引，在体内移位主动脉移植物。记录开始移植物移位所需的位移力，并与破坏缝合吻合所需的力进行比较。动物体重无差异（88.8 ± 2.5 kg vs 87.5 ± 2.9 kg），主动脉瘤颈直径（12.7 +/- 0.9 mm vs 13.4 +/- 1.1 mm），主动脉瘤颈长度（23.2 ± 0.9 mm vs 21.8 ± 2.4 mm），实验动脉瘤尺寸（24.7 +/- 1.1 mm vs 24.2 +/- 2.0 mm）或髂动脉直径（9.0 +/- 1.5 mm vs 9.3 +/- 0.5 mm）。最大髂骨固定组的髂骨固定长度为31.0 ± 0.3 mm，最小固定组为11 ± 0.25 mm（P <0.0001）。在最大髂动脉固定的动物中，启动移位的峰值位移力为30.2 +/- 5.5 N（范围，25 - 38），而在最小固定的动物中为18.1 +/- 3.7 N（范围，13 - 21）（P = 0.01）。破坏对照手术吻合所需的力为40.6 +/- 7.5 N（范围：31 - 50）（P <0.01）。结论：最大化髂动脉固定长度可使完全支撑支架移植物移位所需的纵向体内力增加67%。这表明增加髂动脉固定长度可降低接受动脉瘤腔内修复术患者的长期移位风险。
Purpose: Migration of endovascular stent grafts has been related to the security of proximal device fixation to the aortic neck. This study evaluated the importance of iliac fixation in preventing longitudinal in vivo device displacement of a modular, externally supported stent graft.Methods: Experimental ovine infrarenal aneurysms (n = 8) were treated with a fully supported, modular, bifurcated stent graft (AneuRx, Medtronic, Santa Rosa, Calif). Minimum iliac fixation length (1 cm) was used in four animals and iliac extender modules were used to achieve maximum iliac fixation in four animals. Suture anastomosis of bifurcated polyester grafts to the infrarenal aorta served as controls (n = 8). Aortic grafts were displaced in vivo by applying downward traction to a guidewire that was passed over the iliac flow divider and brought out both femoral arteries. The displacement force needed to initiate stem-graft migration was recorded and compared with the force needed to disrupt the sutured anastomosis.Results: There was no difference in animal weight (88.8 +/- 2.5 kg vs 87.5 +/- 2.9 kg), aortic neck diameter (12.7 +/- 0.9 mm vs 13.4 +/- 1.1 mm), aortic neck length (23.2 +/- 0.9 mm vs 21.8 +/- 2.4 mm), experimental aneurysm size (24.7 +/- 1.1 mm vs 24.2 +/- 2.0 mm), or iliac artery diameter (9.0 +/- 1.5 mm vs 9.3 +/- 0.5 mm) among the groups. Iliac fixation length was 31.0 +/- 0.3 mm in the maximum iliac fixation group and 11 +/- 0.25 mm in the minimum fixation group (P < .0001). Peak displacement force to initiate migration was 30.2 +/- 5.5 N (range, 25 to 38) in animals with maximum iliac fixation compared with 18.1 +/- 3.7 N (range, 13 to 21) in those with minimum fixation (P = .01). The force needed to disrupt the control surgical anastomosis was 40.6 +/- 7.5 N (range, 31 to 50) (P < .01).Conclusions: Maximizing iliac fixation length increases the longitudinal in vivo force needed to displace a fully supported stent graft by 67%. This suggests that increasing iliac fixation length may reduce the long-term risk of migration in patients undergoing endovascular aneurysm repair.