Transcatheter Inoue endovascular graft for treatment of canine aortic dissection

We examined whether the Inoue endovascular graft could be used as a device for the treatment of aortic dissection. This graft consists of a cylinder made from a thin Dacron sheet suspended by several extra-flexible wire rings. Aortic dissections were experimentally created in 11 dogs. Using aortography and intravascular ultrasound imaging (IVUS), we selected the size of the graft diameter according to the diameter of the normal descending aorta (distal to aortic dissection) in 5 dogs (group I) and according to the diameter of the true lumen of the aorta within the aneurysm in 6 dogs (group II). The graft was deployed transfemorally through a 15-F long sheath into the aneurysm to close the entry site, immediately after creation of the aortic dissection. The entry was completely closed in all dogs after immediate implantation. All 5 dogs in group I died within 11 days (mean, 7 days) after graft deployment. However, all grafts in group II were tolerated very well and followed up for as long as 5 months. After the follow up, IVUS and aortography showed no rupture of the aortic aneurysmal wall and no migration, leakage, or damage to the graft in any of the 6 dogs. These 6 dogs were sacrificed and autopsy showed that the graft was covered by a thin, translucent, neointima, effectively recreating a new aortic lumen and completely closing the entry of the aneurysm. The Inoue endovascular graft proved to be effective in the long-term treatment of aortic dissection without surgery, when the size of the graft was selected according to the diameter of the true lumen of the aorta within the aneurysm.