Type II endoleak in porcine model of abdominal aortic aneurysm.
OBJECTIVE
The purpose of this study was to develop a reliable in vivo porcine model of type II endoleak resulting from endovascular aortic aneurysm repair (EVAR), for the study and treatment of type II endoleak.


METHODS
Eight pigs underwent creation of an infrarenal aortic aneurysm, with a Dacron patch with preservation of lumbar branches. An indwelling pressure transducer was placed in the aneurysm sac. After 1 week the animals underwent EVAR with a custom-made Talent endograft. After another week the animals underwent laparoscopic lumbar artery ligation. Abdominal and pelvic computed tomography was performed after each procedure. Aneurysm sac pressure was measured in sedated and awake animals.


RESULTS
All eight animals underwent successful creation of an aortic aneurysm and EVAR resulting in exclusion of the aneurysm sac. After creation of the aneurysm the sac mean arterial pressure (MAP) was 72.5 +/- 6.1 mm Hg and the sac pulse pressure was 44.8 +/- 8.7 mm Hg. Postoperative computed tomography scans demonstrated a type II endoleak from the lumbar branches in all animals. While aneurysm sac MAP (56.5 +/- 7.9 mm Hg; P <.01) and pulse pressure (13.6 +/- 4.1 mm Hg; P <.01) decreased after EVAR, sac pulse pressure remained, with type II endoleak. All animals underwent laparoscopic lumbar artery ligation, which resulted in further reduction in the sac MAP (38.3 +/- 4.6 mm Hg; P <.02) and immediate absence of sac pulse pressure (0 mm Hg; P <.01). Necropsy confirmed the absence of collateral flow in the aneurysm sac, with fresh thrombus formation in all animals.


CONCLUSIONS
We present a reliable and clinically relevant in vivo large animal model of type II endoleak.


CONCLUSIONS
We set out to show that aortic aneurysm sac pressurization caused by lumbar arterial flow in the setting of type II endoleak can be reproduced in an in vivo porcine model of endovascular aortic aneurysm repair. Indeed, in this model the aneurysm sac pulse pressure was a sensitive indicator of type II endoleak, correlating well with findings at computed tomography, and lumbar artery ligation eliminated the endoleak, as demonstrated on computed tomography scans and sac pressure measurement. Therefore we believe this in vivo large animal model can be instrumental in the study of many aspects of the physiologic features of type II endoleak.
Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
Sergio
S
Diaz
Matthew R
MR
Uzieblo
Ketan M
KM
Desai
Michael R
MR
Talcott
Kyongtae T
KT
Bae
Patrick J
PJ
Geraghty
Juan C
JC
Parodi
Gregorio A
GA
Sicard
Luis A
LA
Sanchez
Eric T
ET
Choi
D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D023421:Models, Animal; D011475:Prosthesis Failure; D034421:Sus scrofa; D014057:Tomography, X-Ray Computed