Exclusion of lumbar arteries by aortic endovascular grafts: can angiography demonstrate sealing characteristics?
BACKGROUND
This study evaluates sealing characteristics of two designs of endovascular grafts by angiographic demonstration of exclusion of porcine lumbar arteries.


METHODS
6 endovascular grafts (3 self-expandable with integrated polyurethane wall versus 3 nitinol structures covered with polyester fabric) were implanted in 6 porcine aortae. Perfusion of lumbar arteries was assessed by angiography after implantation and by angiography and dissection at graft explantation after 4 +/- 2 months. Tissue healing was evaluated by light and scanning electron microscopy.


RESULTS
Immediate exclusion of the lumbar arteries was achieved in 14/31 vessels (12 by polyurethane grafts and 2 by polyester grafts, p < 0.001). Follow-up angiography and dissection at explantation revealed perfusion of 30/31 lumbar arteries with a collateral network in most cases. Another reason for reperfusion of initially excluded branches was distention of the polyurethane grafts with resulting shortening allowing reperfusion of 8 of the 31 originally covered branches. Histological examination revealed a complete neointimal lining and a tight contact between endovascular grafts and aorta.


CONCLUSIONS
The immediate angiographic demonstration of exclusion of lumbar arteries predicts sealing characteristics of endovascular grafts. Later angiographic reappearance is due to development of a collateral network and possible shortening of self-expandable devices.
Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland.
B
B
Marty
L K
LK
von Segesser
P
P
Ruchat
S
S
Fischer
D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D008159:Lumbar Vertebrae / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000648:ultrastructure; D011093:Polyethylene Terephthalates; D011140:Polyurethanes; D011474:Prosthesis Design; D013552:Swine; D013556:Swine, Miniature
D011093:Polyethylene Terephthalates; D011140:Polyurethanes