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Mechanical Performances Assessment Of Physician-Modified Aortic Stent-Graft:

  • Jennifer Canonge
    Affiliations
    Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France

    Department of Vascular Surgery, Henri Mondor Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Créteil, France
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  • Frédéric Heim
    Affiliations
    Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France

    Laboratoire de Physique et Mécanique Textiles (LPMT), ENSISA, Mulhouse, France
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  • Nabil Chakfé
    Affiliations
    Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France

    Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
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  • Raphael Coscas
    Affiliations
    UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France

    Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Boulogne-Billancourt

    Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France
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  • Frédéric Cochennec
    Affiliations
    Department of Vascular Surgery, Henri Mondor Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Créteil, France
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  • Jérémie Jayet
    Correspondence
    Corresponding author:J Jayet, MD,PhD, Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, and Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France. UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France. @:
    Affiliations
    Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France

    Laboratoire de Physique et Mécanique Textiles (LPMT), ENSISA, Mulhouse, France

    UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France

    Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Boulogne-Billancourt

    Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France
    Search for articles by this author
Published:November 04, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.11.004
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      Abstract:

      Objective

      The purpose of this study was to compare various fenestration configurations of physician-modified aortic stent-graft in order to identify, which design parameters have a significant influence on the mechanical behavior of the fenestration.

      Materials

      The fenestration configurations were considered according to different manufacturing parameters (cutting technique, fenestration reinforcement, suture material, reinforcement loop design, amount of suture points). The performances of the graft/bridging stent assembling were assessed at various levels: (1) branch pullout force; (2) fenestration enlargement and rupture strength; (3) balloon angioplasty resistance; (4) behavior under cyclic fatigue.

      Results

      60 manual fenestrations were created in total. The tests performed on the fenestrations bring out several main findings. First, the reinforcement increases the radial force on the branch, which increases the pullout force. This may limit the migration of the bridging stent in vivo. The phenomenon is amplified with the snare reinforced fenestration which seems the most efficient. Moreover, increasing the number of suture passes, appears also to increase the branch extraction force, securing the assembling. With respect to the enlargement tests, they show that non reinforced fenestrations present the weakest radial strength. This is confirmed with the balloon angioplasty test, which shows that these latter specimens undergo the most significant textile degradation. After fatigue tests, all fenestrations presented a larger size, showing that the elastic recoil was incomplete in all samples. The largest recoil was observed in the non-reinforced/OC fenestrations (40 %). Regarding the behavior of the samples up to rupture, all samples behaved in a similar way. However, the double loop fenestration strength level was the highest.

      Conclusion

      Our study demonstrated that the Snare double loop reinforcement presents an advantage regarding the durability of a graft/branch assembling. Moreover, non-reinforced fenestrations show signs of weakness and lack of stability, which questions the in situ or laser fenestration procedures.

      Key-words

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