Development of a branched stent-graft for endovascular repair of aortic arch aneurysms.
OBJECTIVE
To develop a branched stent-graft for endovascular repair of aortic arch aneurysm.


METHODS
Four different prototypes of a branched aortic stent-graft were inserted into a rubber model of the human aortic arch under fluoroscopic guidance. Each prototype was tested, modified, and tested again through a series of 4 iterations. The first 3 prototypes had multiple short side branches, as docking sites for extensions into the branches of the aortic arch. The last iteration had only 1 short branch for an extension into the distal aorta and 1 long branch for direct perfusion of the innominate artery.


RESULTS
With every re-design, the prototype aortic stent-graft became shorter, and its insertion site moved to a more proximally located arch artery. Stent-graft insertion, orientation, and extension also became quicker and easier with each change in device design. However, the only system to perform reliably was the last, which was subsequently used to treat a large, symptomatic pseudoaneurysm of the aortic arch in a high-risk patient.


CONCLUSIONS
None of our multibranched systems was simple, safe, or durable enough for insertion into the aortic arch; only an iteration that had a short branch for an extension into the distal aorta and a long branch for direct perfusion of the innominate artery could be deployed without difficulty or delay.
Chuter
Timothy A M
TA
Division of Vascular Surgery, University of California, San Francisco, California 94143, USA. chutert@surgery.ucsf.edu
Buck
David G
DG
Schneider
Darren B
DB
Reilly
Linda M
LM
Messina
Louis M
LM
D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001807:Blood Vessel Prosthesis; D006801:Humans; D011474:Prosthesis Design; D015607:Stents