+1 Recommend
0 collections
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Secondary Fill Minimizes Gutter Size in Chimney EVAS Configurations In Vitro

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.


          Purpose: To investigate in an in vitro model if secondary endobag filling can reduce gutter size during chimney endovascular aneurysm sealing (chEVAS). Materials and Methods: Nellix EVAS systems were deployed in 2 silicone juxtarenal aneurysm models with suprarenal aortic diameters of 19 and 24 mm. Four configurations were tested: EVAS with 6-mm balloon-expandable (BE) or self-expanding (SE) chimney grafts (CGs) in the renal branches of both models. Balloons were inflated simultaneously in the CGs and main endografts during primary and secondary endobag filling and polymer curing. Computed tomography (CT) was performed immediately after the primary and secondary fills. Cross-sectional lumen areas were measured on the CT images to calculate gutter volumes and percent change. CG compression was calculated as the reduction in lumen surface area measured perpendicular to the central lumen line. The largest gutter volume and highest compression were presented per CG configuration per model. Results: Secondary endobag filling reduced the largest gutter volumes from 99.4 to 73.1 mm 3 (13.2% change) and 84.2 to 72.0 mm 3 (27.6% change) in the BECG configurations and from 67.2 to 44.0 mm 3 (34.5% change) and 92.7 to 82.3 mm 3 (11.2% change) in the SECG configurations in the 19- and 24-mm models, respectively. Secondary endobag filling increased CG compression in 6 of 8 configurations. BECG compression changed by −0.2% and 5.4% and by −1.0% and 0.4% in the 19- and 24-mm models, respectively. SECG compression changed by 10.2% and 16.0% and by 7.2% and 7.3% in the 19- and 24-mm models, respectively. Conclusion: Secondary endobag filling reduced paragraft gutters; however, this technique did not obliterate them. Increased CG compression and prolonged renal ischemia time should be considered if secondary endobag filling is used.

          Related collections

          Most cited references 35

          • Record: found
          • Abstract: found
          • Article: not found

          Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry.

          We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment.
            • Record: found
            • Abstract: found
            • Article: not found

            Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms.

            Juxtarenal aortic aneurysms (JAA) can be successfully treated by fenestrated/branched endografts (FBE), but with significant cost and a long manufacturing process. "Chimney" grafts (CG) have been advocated as a cheaper and immediately available alternative. Because scant data are available, the aim of this study was to report our early experience with CG to treat JAA.
              • Record: found
              • Abstract: found
              • Article: not found

              In vitro non-rigid life-size model of aortic arch aneurysm for endovascular prosthesis assessment.

              It is essential to evaluate new stent designs before in vivo testing. The purpose of this study was to develop and validate a controlled and reproducible patient-derived process to produce a life-size in vitro model of aortic arch aneurysm for endovascular procedure simulation. A three-dimensional magnetic resonance angiography (3D MRA) image derived from a 60-year-old patient with aortic arch aneurysm was segmented using a home-made software package which allows one-click automatic segmentation of the aorta, meshing, and conversion to standard tessellation language (STL) format. A rapid prototyping technique established a stereolithographic model to produce a replica of the whole aorta, including the arch aneurysm and supra-aortic arteries. The final model was made by pouring silicone rubber to obtain a sturdy, life-size, soft, transparent, plastic cast, accurately reproducing both the internal and external anatomy of the aortic aneurysm. This model was used under perfusion by an extracorporeal circulation pump, to test ex vivo stent deployment. The combination of easy segmentation and conversion to the STL format with industrial stereolithography techniques enabled a realistic silicon vascular phantom to be created for endovascular procedure simulation, image modality calibration, and new stent design.

                Author and article information

                J Endovasc Ther
                J. Endovasc. Ther
                Journal of Endovascular Therapy
                SAGE Publications (Sage CA: Los Angeles, CA )
                21 December 2018
                February 2019
                : 26
                : 1
                : 62-71
                [1 ]Department of Vascular Surgery, VU University Medical Center, Amsterdam, the Netherlands
                [2 ]Department of Interventional Radiology, VU University Medical Center, Amsterdam, the Netherlands
                [3 ]Department of Surgery, Westfriesgasthuis, Hoorn, the Netherlands
                Author notes
                Kak K. Yeung, Departments of Surgery and Physiology, VU University Medical Center Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, the Netherlands. Emails: k.yeung@ 123456vumc.nl

                Theodorus G. van Schaik and Jorn P. Meekel contributed equally to this work and have shared first authorship.

                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Funded by: Endologix;
                Endovascular Aneurysm Sealing


                Comment on this article