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Deployment of stent graft in an excessively higher position above the renal artery induces a flow channel to the aneurysm in chimney endovascular aortic aneurysm repair: an in vitro study

  • Kota Shukuzawa
  • Taku Akaoka
  • Mitsuo Umezu
  • Takao Ohki
  • Kiyotaka IwasakiEmail author
Original Article Blood Vessel Prosthesis
  • 54 Downloads

Abstract

We aimed to investigate the influences of the sealing length above the renal artery (RA) on gutter formation, non-apposed regions between the aortic wall, stent graft (SG), and chimney graft and incidence of flow channel to the aneurysm in chimney endovascular aortic aneurysm repair (Ch-EVAR) using a juxtarenal abdominal aortic aneurysm model. Neck diameter and length of the silicone model were 24 and 4 mm, respectively. In double Ch-EVAR configuration using Advanta V12, 12 combinations were tested three times with two sizes [28.5 (20%-oversize) and 31 (30%-oversize) mm] of Excluder SG, three sealing lengths above the RA (10, 20, and 30 mm), and two deployment positions (anatomical and cross-leg). Gutter area, non-apposed region, and flow channels to the aneurysm were analyzed using micro-computed tomography. Average gutter area and non-apposed region of 30%-oversize SG were significantly smaller than those of 20%-oversize SG (p = 0.05). Furthermore, the non-apposed region of 30%-oversize SG with a 30-mm sealing length was significantly larger than that of the other sealing lengths. For 20%-oversize SGs, flow channel to the aneurysm was observed, except for the anatomical deployment with the sealing length of 10 mm. For 30%-oversize SGs, flow channel was absent, except for the SG with a 30-mm sealing length in both deployment positions. These flow channels were frequently formed through a valley space, existing in the lower unibody above the two limbs. Our data indicated that the optimal sealing length should be chosen in consideration of the device design difference due to the device diameter in Ch-EVAR.

Keywords

Juxtarenal aortic aneurysm Endovascular aortic repair Chimney technique Gutter In vitro 

Notes

Acknowledgements

This study was supported by the Subsidy Program for Development of International Standards for Evaluation of Innovative Medical Devices and Regenerative Medicine Products, from the Ministry of Health, Labour and Welfare, Japan. The Excluder® was provided by W.L. Gore and Associates.

Compliance with ethical standards

Conflict of interest

Dr. Takao Ohki is a consultant for W.L. Gore and Associates.

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Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  1. 1.Cooperative Major in Advanced Biomedical SciencesJoint Graduate School of Tokyo Women’s Medical University and Waseda UniversityTokyoJapan
  2. 2.Division of Vascular Surgery, Department of SurgeryJikei University School of MedicineTokyoJapan
  3. 3.Department of Modern Mechanical EngineeringWaseda UniversityTokyoJapan
  4. 4.Faculty of Science and EngineeringWaseda UniversityTokyoJapan

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