RESUMEN
Endovascular device specifications and technical improvements are strongly required, especially in particular anatomical locations such as the aortic arch and the thoracoabdominal aorta. We present a new technique for total endovascular repair of the aortic arch and an experimental design of a circulation model in the human cadaver in order to evaluate the feasibility of this technique.
Asunto(s)
Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Aorta Torácica/fisiología , Aortografía , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Cadáver , Estudios de Factibilidad , Humanos , Ensayo de Materiales , Perfusión , Diseño de Prótesis , Flujo Pulsátil , Flujo Sanguíneo Regional , StentsRESUMEN
The aim of this experimental study is to evaluate the feasibility of endovascular repair of the complete aortic arch by using novel fenestration devices with simultaneous support of the cerebral circulation. Two fresh human cadavers and five Yorkshire pigs were used for the experiments. In human cadavers the thoracic aorta was pressurized using a roller pump to simulate the circulation. In animal experiments right femoral artery to right distal carotid artery bypass circuit was achieved in order to support the cerebral circulation during the stent graft deployment, fenestration and conduit fixation procedures. Commercially available Valiant Thoracic Stent Grafts, covered stents, steerable guiding catheters and dilatation balloons were used. Stent grafts were deployed successfully and two fenestrations and one conduit implantation were achieved in each cadaver. All animals survived the stent graft implantation, fenestration and conduit implantation procedures. Cadaver dissection and necropsy of the animals revealed good fixation of the conduits into the fenestrated segments of the stent graft. Endovascular repair of the total aortic arch via in situ fenestration of the stent graft using cerebral circulatory support seems to be feasible and safe. Further studies are required before clinical adoption of this procedure.