Mechanism-guided endograft explantation eliminates shear-mediated aortic injury in a controlled simulation study

Endograft explantation is associated with high morbidity and mortality, driven in part by uncontrolled shear-mediated aortic injury. In this study, we evaluated whether a mechanism-based explantation device could reduce this injury and improve the procedural performance.

In a controlled simulation using a multilayered three-dimensional printed aortic model, 25 vascular trainees and surgeons performed endograft explantation using both a conventional syringe technique and a novel device (EndoEx). The outcomes included quantitative intimal injury, procedure time, and validated usability metrics.

The EndoEx device reduced intimal injury by approximately 90% compared with the syringe technique (0.94% vs 9.56%; P < .001), representing near-elimination of shear-mediated disruption. The procedure time was moderately longer (+32 seconds; P < .05). EndoEx demonstrated superior usability across all domains, including ease of use, safety perception, and overall cognitive load (P < .05).

In this controlled simulation, a mechanism-based explantation strategy (EndoEx) markedly reduced shear-mediated aortic injury while improving operator control. These findings support further in vivo evaluation and establish a mechanistic foundation for a device-based approach to endovascular aneurysm repair explantation that warrants clinical validation.