title: Type A aortic dissection model to improve endovascular research and technologies.
abstract: OBJECTIVE
  Type A aortic dissection is a life-threatening disease requiring immediate surgical treatment. With emerging catheter-based technologies, endovascular stent-graft implantation to treat aneurysms and dissections has become a standardized procedure. However, endovascular treatment of the ascending aorta remains challenging. Thus we designed an ascending aortic dissection model to allow simulation of endovascular treatment.
  
  
  METHODS
  Five formalin-fixed human aortas were prepared. The ascending aorta was opened semicircularly in the middle portion and the medial layer was separated from the intima. The intimal tube was readapted using running monofilament sutures. The preparations were assessed by 128-slice computed tomography. A bare-metal stent was implanted for thoracic endovascular aortic repair in 4 of the aortic dissection models.
  
  
  RESULTS
  Separation of the intimal and medial layer of the aorta was considered to be sufficient because computed tomography showed a clear image of the dissection membrane in each aorta. The dissection was located 3.9 ± 1.4 cm proximally from the aortic annulus, with a length of 4.6 ± 0.9 cm. Before stent implantation, the mean distance from the intimal flap to the aortic wall was measured as 0.63 ± 0.163 cm in the ascending aorta. After stent implantation, this distance decreased to 0.26 ± 0.12 cm.
  
  
  CONCLUSIONS
  This model of aortic dissection of the ascending human aorta was reproducible with a comparable pathological and morphological appearance. The technique and model can be used to evaluate new stent-graft technologies to treat type A dissection and facilitate training for surgeons.
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Bern, Switzerland ppheinisch@googlemail.com.
authors.forename: Paul Philipp
authors.initials: PP
authors.lastname: Heinisch
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Winkler
authors.affiliation: Department of Vascular Surgery, Klinikum Neuperlach, Munich, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Weidenhagen
authors.affiliation: Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Klaws
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Canter, Los Angeles, CA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Khoynezhad
authors.affiliation: Department of Vascular Surgery, Klinikum Neuperlach, Munich, Germany Division of Cardiothoracic Surgery, Cedars-Sinai Medical Canter, Los Angeles, CA, USA.
authors.forename: Rene
authors.initials: R
authors.lastname: Bombien
mesh_terms: D059925:Anatomic Landmarks; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation; D005404:Fixatives; D005557:Formaldehyde; D006801:Humans; D008670:Metals; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015607:Stents; D016707:Tissue Fixation / Q000379:methods
chemical_list: D005404:Fixatives; D008670:Metals; D005557:Formaldehyde
keywords: Aneurysm; Endovascular procedures; In vitro techniques; Stents; Vascular surgical procedures; dissecting