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Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations
Jérémie Jayet1,2,3,4, Jennifer Canonge1,2,5, Frédéric Heim2,3
1Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 92100 Boulogne-Billancourt, France.
Journal of Clinical Medicine
|August 12, 2023
Summary
Custom-made fenestrations, including Zenith Cook and Anaconda, demonstrated superior radial and branch pull-out strength for juxta and pararenal abdominal aortic aneurysms. Physician-modified stent-grafts (PMSG) and laser in situ fenestrations (LISF) show potential but require protocol standardization.
Area of Science:
- Biomaterials Science
- Medical Device Engineering
- Vascular Surgery
Background:
- Fenestrated endografts (FE) are standard for juxta/pararenal AAA.
- Physician-modified stent-grafts (PMSG) and laser in situ fenestration (LISF) offer alternatives to FE.
- Manufacturing delays, anatomic fit, and cost drive interest in alternatives.
Purpose of the Study:
- To compare the mechanical properties of different fenestration techniques.
- Evaluate radial strength, branch pull-out force, and fatigue resistance.
- Assess the performance of custom-made versus standard fenestrations.
Main Methods:
- Tested Zenith Cook and Anaconda fenestrations, plus LISF and PMSG on PET material.
- Performed radial extension tests and branch pull-out force measurements.
- Conducted fatigue tests with oversized branches to simulate long-term stress.
Main Results:
- Custom-made fenestrations (Zenith Cook, Anaconda) exhibited higher radial strength (up to 33.4 N) and branch pull-out force.
- Double loop PMSG showed significantly higher strength than LISF (3.96 N vs. 2.7 N, p=0.018).
- Non-reinforced fenestrations had the largest elastic recoil (40%), while LISF had 10% recoil.
Conclusions:
- Custom-made fenestrations provide superior mechanical strength for endovascular repair of AAA.
- Standardization of PMSG and LISF protocols is needed to optimize their performance.
- Mechanical evaluation is crucial for improving fenestrated endograft designs.
