M Malina, B Lindblad, K Ivancev, M Lindh, J Malina, J Brunkwall
{"title":"血管内AAA排除:有钩和倒钩的支架会阻止支架移植物迁移吗?","authors":"M Malina, B Lindblad, K Ivancev, M Lindh, J Malina, J Brunkwall","doi":"10.1177/152660289800500404","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta.</p><p><strong>Methods: </strong>Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force.</p><p><strong>Results: </strong>The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects.</p><p><strong>Conclusions: </strong>Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/152660289800500404","citationCount":"0","resultStr":"{\"title\":\"Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration?\",\"authors\":\"M Malina, B Lindblad, K Ivancev, M Lindh, J Malina, J Brunkwall\",\"doi\":\"10.1177/152660289800500404\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta.</p><p><strong>Methods: </strong>Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force.</p><p><strong>Results: </strong>The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects.</p><p><strong>Conclusions: </strong>Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. 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引用次数: 0
摘要
目的:探讨钩倒钩支架是否能改善腹主动脉支架固定。方法:采用直径16 ~ 24mm的涤纶在尸体主动脉内布放。在血管内腹主动脉瘤修复中,移植物被支架固定。采用改良的自膨胀z型支架进行了137次支架移植部署,其中(A)无钩和倒钩(n = 75), (B) 4个5毫米长的钩和倒钩(n = 39), (C) 8个10毫米长的加强钩和倒钩(n = 19),或(D)只有钩(n = 4)。增加纵向牵引以确定提取支架移植物所需的位移力。测量支架的径向力,并将其与位移力相关联。结果:A支架锚定移植物拔出所需位移力中位数(四分位数范围)为2.5 N (2.0 ~ 3.4), B支架为7.8 N (7.4 ~ 10.8), C支架为22.5 N (17.1 ~ 27.9), p < 0.001。钩子和倒钩都增加了锚的强度。牵引时,较弱的倒钩扭曲或引起内膜撕裂。较强的倒钩钩住了整个主动脉壁。支架的径向力对固定无影响,而主动脉钙化和移植物过大对固定无影响。结论:支架倒钩和支架钩使支架的固定增加了10倍,而支架的径向力对支架的固定没有影响。这些数据可能对未来内移植物的发展具有重要意义,以防止动脉瘤排除后支架移植物的迁移。
Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration?
Purpose: To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta.
Methods: Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force.
Results: The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects.
Conclusions: Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.