Anterior Patch Aortic Aneurysm Model for the Study of Endoluminal Grafts

Abstract

Endovascular graft repair for aortic aneurysms has led to concerns regarding the healing characteristics of the graft within a thrombus-lined aneurysm and the effect that collateral flow may have on the endoluminal prosthesis and the aneurysm. An anterior aortic patch aneurysm model that preserved collateral arteries was examined and modified to address these issues. In canines (n = 30) a Dacron knitted patch (n = 27) or a rectus fascia patch (n = 3) was sutured into a 3.5-cm anterior aortotomy. Dacron patch aneurysm diameter was an average of 21.8 2 2.2 mm (mean canine normal aortic diameter 9.06 ± 0.79 mm). Canines underwent angiogram, computed tomography, and/or intravascular ultrasound from 1 to 11 weeks later, at which time an endoluminal prosthesis was deployed and followed 30 to 60 days until harvest. Aneurysms accumulated minimal thrombus through the initial II weeks. Significant stenosis (mean 21.2% 2 19%) occurred at aneurysm necks in association with a patch imbrication suture technique (n = 11). Following modification (n = 16), this decreased to a mean of 3.6 2 9.7%. Collateral lumbar artery patency was 95% at the time of imaging prior to graft placement. Following successful graft implantation, 16 of I8 aneurysms were filled with thrombus and in most cases the collateral circulation occluded. One of three fascia1 patch aneurysms ruptured 21 days after creation. This model more accurately depicts abdominal aortic aneurysms with the inherent thrombus and collateral flow that is important when studying aspects of endovascular aortic graft repair.

Key Words:

• endovascular
• endoluminal graft
• aortic aneurysm intravascular ultrasound
• computed tomography