title: In Vitro Laser Fenestration of Aortic Stent-Grafts: A Qualitative Analysis Under Scanning Electron Microscope.
abstract: In situ fenestration of stent-grafts allows patients with life threatening aortic pathologies to be amenable to emergent "off the shelf indications for use" percutaneous treatments as a bail out technique. Three types of aortic stent-grafts were subjected to laser fenestration in a physiological saline solution followed by balloon angioplasty using 8, 10 or 12 mm in diameter noncompliant balloons. The morphology and the size of fenestrations were observed under optical and scanning electron microscopy. The damage to the fabrics was analyzed and quantified. The creation of fenestrations was feasible in all devices, with varying degrees of fraying and/or tearing. The monofilament twill weave (Medtronic Valiant) tore in two directions (warp and weft) while the multifilament weave fenestrations showed more fraying (Anaconda Vascutek and Zenith TX2 Cook). The size and directions of tearing were more predictable with the 8 mm diameter balloon whereas the results obtained with the 10 and 12 mm diameter balloons were more unpredictable. The fenestrations were free of melting of the yarns and blackening of the filaments. The in situ fenestration is feasible but the observed damage to the fabric constructions must be carefully considered. This procedure must currently be limited to urgent and emergent life threatening cases because it is off indications for use for approved devices.
authors.affiliation: Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA.
authors.forename: Naval
authors.initials: N
authors.lastname: Udgiri
authors.affiliation: Department of Surgery, Faculty of Medicine, Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU, Québec, QC.
authors.forename: Robert
authors.initials: R
authors.lastname: Guidoin
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Panneton
authors.affiliation: Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China.
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Guan
authors.affiliation: Department of Surgery, Faculty of Medicine, Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU, Québec, QC.
authors.forename: Maxime
authors.initials: M
authors.lastname: Guillemette
authors.affiliation: Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Du
authors.affiliation: Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China.
authors.forename: Dajie
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Division of Vascular Surgery and Department of Diagnostic Imaging, University of Calgary, Peter Lougheed Center, Calgary, AB, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Nutley
authors.affiliation: Department of Surgery, Faculty of Medicine, Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU, Québec, QC.
authors.forename: Ze
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D006801:Humans; D007834:Lasers; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D011474:Prosthesis Design; D036301:Qualitative Research; D015607:Stents
keywords: Aortic stent-grafts; Balloon; Fabric; Fray; In situ; Off-label; Tear