title: Engineering goals for future thoracic endografts-how can we make them more effective?
abstract: Endovascular treatments for catastrophic aortic conditions have gained increasing popularity over the past 20 years. Originally developed for abdominal aortic aneurysms (EVAR), treatment has been modified for use in thoracic aortic repair (TEVAR). As expanding numbers of patients with increasingly intractable conditions and more hostile anatomies are treated, endovascular stent designs are maturing to be suitable for these more demanding situations. This article discusses the engineering considerations that apply to changing stent graft designs for current and evolving thoracic applications. The biological parameters that differentiate thoracic from abdominal aortic environments are outlined. Factors concerning materials, sealing mechanisms, deployment, stent frame architecture, and migration resistance are described, and eagerly awaited potential future developments are summarized.
authors.affiliation: Department of Endovascular Therapies Research and Development, Medtronic Cardiovascular, Santa Rosa, CA.
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Weidman
authors.forename: Malhar
authors.initials: M
authors.lastname: Desai
authors.forename: Arif
authors.initials: A
authors.lastname: Iftekhar
authors.forename: Kevin
authors.initials: K
authors.lastname: Boyle
authors.forename: Judith S
authors.initials: JS
authors.lastname: Greengard
authors.forename: Lois M
authors.initials: LM
authors.lastname: Fisher
authors.forename: Richard L S
authors.initials: RL
authors.lastname: Thomas
authors.forename: Simona
authors.initials: S
authors.lastname: Zannetti
mesh_terms: D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000266:history / Q000639:trends; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000266:history / Q000295:instrumentation* / Q000639:trends; D017076:Computer-Aided Design; D057510:Endovascular Procedures / Q000009:adverse effects / Q000266:history / Q000295:instrumentation* / Q000639:trends; D005544:Forecasting; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design / Q000266:history / Q000639:trends; D011475:Prosthesis Failure; D015607:Stents / Q000266:history / Q000639:trends; D016896:Treatment Outcome
keywords: Aneurysm; CT; DTA; Design; EVAR; Engineering; IVUS; Nitinol; OSR; PET; SINE; Stent graft; TAVI; TEVAR; Thoracic endovascular aortic repair; abdominal endovascular aneurysm repair; computed tomography; degenerative thoracic aneurysms; ePTFE; expanded polytetrafluoroethylene; nickel–titanium alloy; open surgical repair; polyethylene terepthalate; rAD; real-time intravascular ultrasound; retrograde type A dissection; stent graft-induced new entry; thoracic endovascular aortic repair; transaortic valve implantation