In vivo antegrade fenestration of abdominal aortic stent-grafts.
OBJECTIVE
To examine in a canine model the feasibility of antegrade fenestration of abdominal aortic stent-grafts to preserve the patency of the renal arteries.


METHODS
Two large dogs underwent antegrade fenestration of stent-grafts in the perirenal aorta. Before fenestration, bare stents were inserted in both renal arteries as fluoroscopic landmarks. A 12-mm iliac extension served as the canine aortic endograft. The first procedure was done under ultrasound and fluoroscopic guidance, using an intravascular ultrasound (IVUS) probe inserted in the vena cava and a Pioneer IVUS catheter. The second was performed exclusively under fluoroscopic guidance with a Brockenbrough needle. Angiograms and duplex ultrasound were planned for 1 month, after which the dogs would be sacrificed for autopsy. The explanted endograft was subjected to biomaterials analysis, with a focus on fabric tear.


RESULTS
Perforation of the aortic graft and catheterization of the renal arteries with a floppy guidewire were possible in both animals. In dog 1, aortic graft dilation and subsequent fenestration were not possible, and the experiment was terminated. However, the procedure was successful in both renal arteries of dog 2. At 1-month follow-up in this dog, both renal arteries were patent. Stent fractures were observed bilaterally. There was no extension of the damage to the fabric beyond the area of fenestration.


CONCLUSIONS
In vivo antegrade fenestration of aortic endografts is technically feasible. However, improvements in technique, instrumentation, and materials are required to make it a reliable and reproducible way of allowing stent-graft vascularization of aortic side branches.
Tse
Leonard W H
LW
Division of Vascular Surgery, Peter Lougheed Centre, University of Calgary, Alberta, Canada.
Bui
Bao T
BT
Lerouge
Sophie
S
Salazkin
Igor
I
Therasse
Eric
E
Benko
Andrew
A
Héon
Hélène
H
Oliva
Vincent L
VL
Soulez
Gilles
G
D000818:Animals; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004285:Dogs; D005240:Feasibility Studies; D023421:Models, Animal; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D013997:Time Factors; D018084:Ultrasonography, Interventional; D014654:Vascular Patency