Geometrical consequences of kissing stents and the Covered Endovascular Reconstruction of the Aortic Bifurcation configuration in an in vitro model for endovascular reconstruction of aortic bifurcation.
OBJECTIVE
Kissing stents (KS) are commonly used to treat aortoiliac occlusive disease, but patency results are often lower than those of isolated stents. The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique was recently introduced to reconstruct the aortic bifurcation in a more anatomical and physiological fashion. The aim of this study is to compare the geometrical consequences of various stent configurations in vitro.


METHODS
Anatomic vessel phantoms of the aortoiliac bifurcation were created to accommodate stent configurations. Self-expandable nitinol KS, balloon-expandable covered KS, and two versions of the CERAB configuration were deployed, one with the iliac legs positioned inside the tapered part of the aortic cuff (1) and one with the legs deployed above this level (2). Computed tomography data were obtained to assess the geometry. The conformation ratio (D-ratio) was calculated by use of the ratio of the major and minor axes. The proximal mismatch area, mean mismatch area, and total mismatch volume were calculated.


RESULTS
The highest D-ratios were observed in the nitinol KS and the CERAB configuration, implying an ideal "double-D" shape. The proximal and mean mismatch areas were four- to sixfold lower in the CERAB (1) configuration when compared with nitinol KS and CERAB (2), respectively, whereas the covered KS had the highest mismatch area. Nitinol and covered KS had the largest mismatch volume, whereas the mismatch volume was the lowest in the CERAB (1) configuration.


CONCLUSIONS
Although nitinol self-expandable stents have a high stent conformation, the lowest radial mismatch was found in the CERAB (1) configuration, supporting the hypothesis that the CERAB configuration is the most anatomical and physiological reconstruction of the aortic bifurcation. Within the CERAB configuration, the two limbs are ideally positioned inside the tapering portion of the cuff, minimizing mismatch.
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Erik
E
Groot Jebbink
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Frederike A B
FA
Grimme
Department of Vascular Surgery, Vascular Clinic ZNA, Antwerp, Belgium.
Peter C J M
PC
Goverde
Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands.
Jacques A
JA
van Oostayen
MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Cornelis H
CH
Slump
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: mmpj.reijnen@gmail.com.
Michel M P J
MM
Reijnen
D000497:Alloys; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004867:Equipment Design; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D066298:In Vitro Techniques; D008955:Models, Cardiovascular; D015607:Stents; D014057:Tomography, X-Ray Computed
D000497:Alloys; C013616:nitinol