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Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations

Introduction: A fenestrated endograft (FE) is the first-line endovascular option for juxta and pararenal abdominal aortic aneurysms. A physician-modified stent-graft (PMSG) and laser in situ fenestration (LISF) have emerged to circumvent manufacturing delays, anatomic standards, and the procedure’s...

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Autores principales: Jayet, Jérémie, Canonge, Jennifer, Heim, Frédéric, Coggia, Marc, Chakfé, Nabil, Coscas, Raphaël
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420147/
https://www.ncbi.nlm.nih.gov/pubmed/37568314
http://dx.doi.org/10.3390/jcm12154911
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author Jayet, Jérémie
Canonge, Jennifer
Heim, Frédéric
Coggia, Marc
Chakfé, Nabil
Coscas, Raphaël
author_facet Jayet, Jérémie
Canonge, Jennifer
Heim, Frédéric
Coggia, Marc
Chakfé, Nabil
Coscas, Raphaël
author_sort Jayet, Jérémie
collection PubMed
description Introduction: A fenestrated endograft (FE) is the first-line endovascular option for juxta and pararenal abdominal aortic aneurysms. A physician-modified stent-graft (PMSG) and laser in situ fenestration (LISF) have emerged to circumvent manufacturing delays, anatomic standards, and the procedure’s cost raised by FE. The objective was to compare different fenestrations from a mechanical point of view. Methods: In total, five Zenith Cook fenestrations (Cook Medical, Bloomington, IN, USA) and five Anaconda fenestrations (Terumo Company, Inchinnan, Scotland, UK) were included in this study. Laser ISF and PMSG were created on a Cook TX2 polyethylene terephthalate (PET) cover material (Cook Medical, Bloomington, IN, USA). In total, five LISFs and fifty-five PMSG were created. All fenestrations included reached an 8 mm diameter. Radial extension tests were then performed to identify differences in the mechanical behavior between the fenestration designs. The branch pull-out force was measured to test the stability of assembling with a calibrated 8 mm branch. Fatigue tests were performed on the devices to assess the long-term outcomes of the endograft with an oversized 9 mm branch. Results: The results revealed that at over 2 mm of oversizing, the highest average radial strength was 33.4 ± 6.9 N for the Zenith Cook fenestration. The radial strength was higher with the custom-made fenestrations, including both Zenith Cook and Anaconda fenestrations (9.5 ± 4.7 N and 4.49 ± 0.28 N). The comparison between LISF and double loop PMSG highlighted a higher strength value compared with LISF (3.96 N ± 1.86 vs. 2.7 N ± 0.82; p= 0.018). The diameter of the fenestrations varied between 8 and 9 mm. As the pin caliber inserted in the fenestration was 9 mm, one could consider that all fenestrations underwent an “elastic recoil” after cycling. The largest elastic recoil was observed in the non-reinforced/OC fenestrations (40%). A 10% elastic recoil was observed with LISF. Conclusion: In terms of mechanical behavior, the custom-made fenestration produced the highest results in terms of radial and branch pull-out strength. Both PMSG and LISF could be improved with the standardization of the fenestration creation protocol.
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spelling pubmed-104201472023-08-12 Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations Jayet, Jérémie Canonge, Jennifer Heim, Frédéric Coggia, Marc Chakfé, Nabil Coscas, Raphaël J Clin Med Article Introduction: A fenestrated endograft (FE) is the first-line endovascular option for juxta and pararenal abdominal aortic aneurysms. A physician-modified stent-graft (PMSG) and laser in situ fenestration (LISF) have emerged to circumvent manufacturing delays, anatomic standards, and the procedure’s cost raised by FE. The objective was to compare different fenestrations from a mechanical point of view. Methods: In total, five Zenith Cook fenestrations (Cook Medical, Bloomington, IN, USA) and five Anaconda fenestrations (Terumo Company, Inchinnan, Scotland, UK) were included in this study. Laser ISF and PMSG were created on a Cook TX2 polyethylene terephthalate (PET) cover material (Cook Medical, Bloomington, IN, USA). In total, five LISFs and fifty-five PMSG were created. All fenestrations included reached an 8 mm diameter. Radial extension tests were then performed to identify differences in the mechanical behavior between the fenestration designs. The branch pull-out force was measured to test the stability of assembling with a calibrated 8 mm branch. Fatigue tests were performed on the devices to assess the long-term outcomes of the endograft with an oversized 9 mm branch. Results: The results revealed that at over 2 mm of oversizing, the highest average radial strength was 33.4 ± 6.9 N for the Zenith Cook fenestration. The radial strength was higher with the custom-made fenestrations, including both Zenith Cook and Anaconda fenestrations (9.5 ± 4.7 N and 4.49 ± 0.28 N). The comparison between LISF and double loop PMSG highlighted a higher strength value compared with LISF (3.96 N ± 1.86 vs. 2.7 N ± 0.82; p= 0.018). The diameter of the fenestrations varied between 8 and 9 mm. As the pin caliber inserted in the fenestration was 9 mm, one could consider that all fenestrations underwent an “elastic recoil” after cycling. The largest elastic recoil was observed in the non-reinforced/OC fenestrations (40%). A 10% elastic recoil was observed with LISF. Conclusion: In terms of mechanical behavior, the custom-made fenestration produced the highest results in terms of radial and branch pull-out strength. Both PMSG and LISF could be improved with the standardization of the fenestration creation protocol. MDPI 2023-07-26 /pmc/articles/PMC10420147/ /pubmed/37568314 http://dx.doi.org/10.3390/jcm12154911 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jayet, Jérémie
Canonge, Jennifer
Heim, Frédéric
Coggia, Marc
Chakfé, Nabil
Coscas, Raphaël
Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
title Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
title_full Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
title_fullStr Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
title_full_unstemmed Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
title_short Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
title_sort mechanical comparison between fenestrated endograft and physician-made fenestrations
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420147/
https://www.ncbi.nlm.nih.gov/pubmed/37568314
http://dx.doi.org/10.3390/jcm12154911
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