title: Experimental evaluation of complete endovascular arch reconstruction by in situ retrograde fenestration.
abstract: BACKGROUND
  The aim of this experimental study was to assess the feasibility of complete endovascular arch reconstruction by in situ retrograde fenestration and to investigate the impact of stent-graft material on stent-graft fenestrations.
  
  
  METHODS
  The experiments were performed using 8 cadaveric human thoracic aortas (aortic arch) using 2 different stent-graft types: woven polyester (Valiant Captivia; Medtronic Vascular, Santa Rosa, CA) and expanded polytetrafluoroethylene (conformable [C]-TAG; W.L. Gore & Associates, Flagstaff, AZ). A benchtop aortic pulsatile flow model was used. Stent-grafts were deployed into the aortic arch, covering the ostia of the supraaortic trunks. A 5-mm 30-degree angioscope was introduced into the ascending aorta to monitor the procedure. Retrograde fenestration and deployment of the balloon expandable stent-graft was performed sequentially for each supraaortic trunk. Subsequent to stent-graft explantation, macroscopic evaluation of each fenestration was performed.
  
  
  RESULTS
  All attempts to fenestrate the C-TAG and Valiant stent-grafts and implant the covered stent through the supraaortic trunks were successful. In all cases, branch stents were patent and no endoleak was evident. The Valiant stent-graft was easier to puncture because of the higher radial force of the stent-graft providing better counterpressure; however, stent-graft material had no impact on the quality of fenestrations.
  
  
  CONCLUSIONS
  Total endovascular repair of the aortic arch through in situ retrograde fenestration of stent-grafts is feasible. The behavior of the 2 types of stent-graft was significantly different while the fenestrations were fashioned, but stent-graft material had no impact on the quality of fenestrations.
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; INSERM U 1046, Montpellier, France. Electronic address: ludoviccanaud@hotmail.com.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; INSERM U 1046, Montpellier, France.
authors.forename: Elsa Madeleine
authors.initials: EM
authors.lastname: Faure
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Branchereau
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Baris Ata
authors.initials: BA
authors.lastname: Ozdemir
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ané
authors.affiliation: Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; INSERM U 1046, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002102:Cadaver; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D015607:Stents