Endoluminal Treatment of Ruptured Abdominal Aortic Aneurysm with Small Intestinal Submucosa Sandwich Endografts: A Pilot Study in Sheep |
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Authors: | Katsuyuki Yamada Dusan Pavcnik MD PhD Barry T Uchida Hans A Timmermans Christopher L Corless Qiang Yin Koichiro Yamakado Joong Wha Park Josef Rösch Frederick S Keller Morio Sato Ryusaku Yamada |
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Institution: | (1) Dotter Interventional Institute, Oregon Health Sciences University, L342, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA, US;(2) Department of Pathology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA, US;(3) Department of Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA, US;(4) Department of Radiology, Wakayama Medical College, 811 Banchi, Kimiidera, Wakayama-shi, Wakayama, 641-0012, Japan, JP;(5) Department of Radiology, Osaka City University School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan, JP |
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Abstract: | Purpose: To evaluate efficacy of small intestinal submucosa (SIS) Sandwich endografts for the treatment of acute rupture of abdominal
aortic aneurysms (AAA) and to explore the short-term reaction of the aorta to this material.
Methods: In eight adult sheep, an infrarenal AAA was created transluminally by dilation of a short Palmaz stent. In six sheep, the
aneurysm was then ruptured by overdilation of the stent with a large angioplasty balloon. Two sheep with AAAs that were not
ruptured served as controls. A SIS Sandwich endograft, consisting of a Z stent frame with 5 bodies and covered inside and
out with SIS, was used to exclude the ruptured and non-ruptured AAAs. Follow-up aortography was done immediately after the
procedure and before sacrifice at 4, 8, or 12 weeks. Autopsy and histologic studies followed.
Results: Endograft placement was successful in all eight sheep. Both ruptured and non-ruptured AAAs were successfully excluded. Three
animals with AAA rupture developed hind leg paralysis due to compromise of the arterial supply to the lower spinal cord and
were sacrificed 1 day after the procedure. In five animals, three with rupture and two controls, follow-up aortograms revealed
no aortic stenoses and no perigraft leaks. Gross and histologic studies revealed incorporation of the endografts into the
aortic wall with replacement of SIS by dense neointima that was completely endothelialized in areas where the endograft was
in direct contact with the aortic wall. In central portions of the endograft, in contact with the thrombosed aneurysm, endothelialization
was incomplete even at 12 weeks.
Conclusion: The SIS Sandwich endografts effectively excluded simple AAAs and ruptured AAAs. They were rapidly incorporated into the aortic
wall. A detailed long-term study is warranted. |
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Keywords: | : Aortic aneurysm— Aneurysm rupture— Endoluminal treatment— Endovascular grafts— Biomaterials small intestinal submucosa— Animal models |
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