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The proximal fixation strength of modern EVAR grafts in a short aneurysm neck. An in vitro study
W M P F Bosman1, T J V D Steenhoven, D R Suárez
1Department of Surgery, Section Vascular Surgery, Leiden University Medical Center, Postbox 9600, K6-R, 2300 RC Leiden, The Netherlands. w.m.p.f.bosman@lumc.nl
Objectives:
The study aims to measure the strength of the proximal fixation of endografts in short and long necks.
Design:
Three types of endografts were compared: Gore Excluder, Vascutek Anaconda and Medtronic Endurant.
Materials And Methods:
The proximal part of the stent grafts was inserted in bovine arteries and the graft was then attached to a tensile testing machine. The force to obtain dislodgement (DF) from the aorta was recorded for each graft at proximal seal lengths of 10 and 15 mm.
Results:
The median DF (interquartile range, IQR) for the Excluder, the Anaconda and the Endurant with a seal length of 15 mm was: 11.8 (10.5-12.0) N, 20.8 (18.0-30.1) N and 10.7 (10.4-11.3) N. With the shorter proximal seal of 10mm, DF was, respectively: 6.0 (4.5-6.6) N, 17.0 (11.2-36.6) N and 6.4 (6.1-12.0) N.
Conclusions:
The proximal fixation of the Anaconda is superior to the Excluder and the Endurant at short necks of 10 and 15 mm in an experimental set-up. There is a statistically significant decrease of proximal fixation for the Excluder stent graft, when decreasing the length of the proximal neck from 15 to 10 mm.
