Subscribe to RSS
DOI: 10.1055/s-2002-28270
© Georg Thieme Verlag Stuttgart · New York
Endovaskuläre Aneurysmatherapie:
Radiologisch-makropathologische Befundkorrelation der endoluminalen Oberfläche
einer modularen Stentprothese
Endovascular aneurysm treatment: Radiological and macropathological findings of the endoluminal surface of modular stent grafts
Publication History
Publication Date:
07 May 2002 (online)
![](https://www.thieme-connect.de/media/roefo/200205/lookinside/thumbnails/10.1055-s-2002-28270-1.jpg)
Zusammenfassung
Fragestellung: Charakterisierung der endoluminalen Oberfläche einer modularen Stentprothese und Korrelation der makropathologischen Befunde mit den Befunden verschiedener radiologischer Verfahren. Methoden: Bei 36 FBI-Mischlingshunden wurden Aneurysmen der infrarenalen Aorta aus autologem Material experimentell erzeugt und mit einer modularen Stentprothese endovaskulär behandelt. Dazu wurden zwei polyesterummantelte Nitinol-Stents im Aneurysmasack überlappend platziert. Das Follow-up betrug für jeweils 12 Tiere eine Woche, 6 Wochen und 6 Monate. Das Behandlungsergebnis wurde mittels Sonographie, Spiral-CT, MRT, intravaskulärem Ultraschall (IVUS) und digitaler Subtraktionsangiographie (DSA) dokumentiert. Das stentversorgte Gefäßsegment wurde in Längsrichtung aufgetrennt. Vor der histopathologischen Untersuchung wurden die einzelnen Stentsegmente mit der Lupenvergrößerung makropathologisch beurteilt und mit den entsprechenden radiologischen Befunden korreliert. Ergebnisse: In 4 Fällen traten höhergradige Stenosen innerhalb der Stentprothese auf, in zwei Fällen Prothesenverschlüsse. In 5 Fällen konnten höhergradige Stufenbildungen und Separationen der Stentkomponenten an der Konnektionsstelle ursächlich nachgewiesen werden. In drei Fällen waren Migrationen von Prothesenanteilen nachweisbar, in einem Fall führte dies zu einer Diskonnektion der Prothese im Aneurysmasack. Unregelmäßigkeiten der Prothesenhülle und Ablagerungen auf der endoluminalen Oberfläche wurden mit allen radiologischen Methoden systematisch unterschätzt. Der IVUS gestattete eine grobe Einschätzung der Prothesenentfaltung und der Prothesenverankerung, während MRT, Sonographie und CT mit abnehmender Sensitivität eine deutlich schlechtere Befundkonkordanz zeigten. Endoluminale Wandauflagerungen wurden mit kontrastverstärkten T1-w Bildern erkannt, jedoch häufig unterschätzt. DSA, IVUS, CT und Sonographie zeigten eine schlechte Befundkonkordanz. Schlussfolgerungen: Die Konnektionsstelle modularer Stentprothesen prädisponiert zu Stenosen und Prothesenverschlüssen. Keine radiologische Methode erlaubt allein eine optimale Beurteilung der Stentprothese. Der IVUS gestattet eine Beurteilung der Prothesenentfaltung. Endoluminale Auflagerungen sind am besten mittels MRT nachweisbar.
Abstract
Purpose: Characterization of the endoluminal surface of a modular stent graft and correlation of macropathological findings with results of radiological methods. Methods: Aneurysms of the infrarenal aorta were created in 36 mongrel FBI dogs using autologous material. Endovascular treatment was performed with modular stent grafts using two polyester-covered nitinol stents connected with overlap within the aneurysm. Follow-up was 1 and 6 weeks, and 6 months for 12 animals, respectively. Results were documented using sonography, intravascular ultrasound (IVUS), spiral CT, MRI, and digital subtraction angiography (DSA). After fixation, the aorta was prepared and incised lengthwise. Before histopathological work-up, the different segments were macropathologically characterized and correlated with the respective findings of the radiological methods. Results: 4 cases showed high grade stenosis within the stent grafts and graft occlusion occurred in two cases. The connection sites of these modular stent grafts showed steps and partial separation of the graft components was causative in 5 of these cases. Migration of graft components occurred in three cases, one of them with complete disconnection of the modular device. Irregulartities and deposits on the endoluminal surface were systematically underestimated with all radiological techniques used. IVUS showed moderate concordance concerning deployment and unfolding of the stent graft, however, irregularities of the endoluminal surface were systematically underestimated. Concordance of MRI, sonography, and CT was worse. Contrast-enhanced T1-w MRI detected endoluminal deposits with moderate concordance. However, the thickness of deposits was underestimated. DSA, IVUS, and CT showed only poor concordance with macropathological findings. Conclusions: The connection site of modular stent grafts predisposes to stenosis, occlusion, and disconnection of the modular device. Stent deployment and unfolding of the membrane might be examined with IVUS. MRI is useful for detecting endoluminal deposits and stenosis. However, radiological methods will underrate irregularities and deposits of the endoluminal surface.
Schlüsselwörter
Aneurysma - Endovaskulär - Modulare Stentprothesen - IVUS - MRT
Key words
Aortic aneurysms - Endovascular - Modular stent grafts - IVUS - MRI
Literatur
- 1 Parodi J C, Palmaz J C, Barone H D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991; 5 491-499
- 2 Düber C, Schmiedt W, Pitton M B, Neufang A, Eberle B, Wollmann J-C, Oelert H, Thelen M. Endovaskuläre Therapie aortaler Aneurysmen: erste klinische Ergebnisse. Fortschr Röntgenstr. 1996; 164 (1) 55-61
- 3 Parodi J C, Barone A, Piraino R, Schonholz C. Endovascular treatment of abdominal aortic aneurysms: lessons learned. J Endovasc Surg. 1997; 4 102-110
- 4 Blum U, Langer M, Spillner G, Mialhe C, Beyersdorf F, Buitrago-Tellez C, Voshage G, Düber C, Schlosser V, Cragg A H. Abdominal aortic aneurysms: preliminary technical and clinical results with transfemoral placement of endovascular self-expanding stent-grafts. Radiology. 1996; 198 25-31
- 5 Chuter T AM, Wendt G, Hopkinson B R, Scott R AP, Risberg B, Kieffer E, Raithel D, van Bockel J H. European experience with a system for bifurcated stent-graft insertion. J Endovasc Surg. 1997; 4 13-22
- 6 May J, White G H, Yu W, Waugh R, Stephen M S, Sieunarine K, Chaufour X, Harris J P. Endoluminal repair of abdominal aortic aneurysms: strengths and waeaknesses of various prostheses observed in a 4.5-year eyperience. J Endovasc Surg. 1997; 4 147-151
- 7 Okhi T, Veith F J, Shaw P, Lipsitz E, Suggs W D, Wain R A, Bade M, Mehta M, Cayne N, Cynamon J, Valldares J, McKay J. Increasing incidence of midterm and long-term complications after endovascular graft repair of abdominal aortic aneurysms: a note of caution based on a 9-year experience. Ann Surg. 2001; 234 323-335
- 8 Schlensak C, Doenst T, Hauer M, Bitu-Moreno J, Uhrmeister P, Spillner G, Beyersdorf F. Serious complications that require surgical interventions after endoluminal stent-graft placement for the treatment of infrarenal aortic aneurysms. J Vasc Surg. 2001; 34 198-203
- 9 Mahnken A H, Chalabi K, Schurmann K, Schmitz-Rode T, Günther R W. Veränderungen im Bereich des proximalen Aneurysmahalses nach endovaskulärer Ausschaltung infrarenaler Aortenaneurysmen. Fortschr Röntgenstr. 2000; 172 842-846
- 10 Schunn C D, Kruass M, Heilberger P, Ritter W, Raithel D. Aortic aneurysms size and graft behavior after endovascular stent-grafting: clinical experiences and observations over 3 years. J Endovasc Ther. 2000; 7 167-176
- 11 Riepe G, Heintz C, Chakfe N, Morlock M, Gross-Fengels W, Imig H. Stentdrahtbrüche und Maschenlockerungen explantierter endovaskularer Prothesen. Zentralbl Chir. 2000; 125 22-26
- 12 Guidoin R, Marois Y, Douville Y, King M W, Castonguay M, Traore A, Formichi M, Staxrud L E, Norgen L, Bergeron P, Becquemin J P, Egana J M, Harris P L. First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR Registry. J Endovasc Ther. 2000; 7 105-122
- 13 Harris P, Brennan J, Martin J, Gould D, Bakran A, Gilling-Smith G, Buth J, Gevers E, White D. Longitudinal aneurysm shrinkage following endovascular aortic aneurysm repair: a source of intermediate and late complications. J Endovasc Surg. 1999; 6 11-16
- 14 Bequemin J P, Lapie V, Favre J P, Rousseau H. Mid-term results of a second generation bifurcated endovascular graft for abdominal aortic aneurysm repair: the French Vanguard trial. J Vasc Surg. 1999; 30 209-218
- 15 Krauss M, Ritter W, Bär I, Heilberger P, Schunn C, Raithel D. Bildgebung von Aortenendoprothesen und deren Komplikationen. Fortschr Röntgenstr. 1998; 169 (4) 389-397
- 16 Rozenblit A, Marin M L, Veith F J, Cynamon J, Wahl S I, Bakal C W. Endovascular repair of abdominal aortic aneurysm: Value of postoperative follow-up with Helical CT. Am J Roentgenol. 1995; 165 1473-1479
- 17 Pitton M B, Düber C, Neufang A, Schmenger P, Icking-Konert B, Bro S, Thelen M. Druckentlastung im Aneurysmasack nach endovaskulärer Therapie von Aortenaneurysmen. Fortschr Röntgenstr. 2000; 172 198-194
- 18 Beebe H G, Cronenwett J L, Katzen B T, Brewster D C, Green R M. Results of an aortic endograft trial: impact of device failure beyond 12 months. J Vasc Surg. 2001; 33 S55-63
- 19 Mialhe C, Amicabile C, Becquemin J P. Endovascular treatment of infrarenal abdominal aneurysms by the Stentor system: Preliminary results of 79 cases. J Vasc Surg. 1997; 26 199-209
- 20 Matsumura J, Moore W. Clinical consequences of periprosthetic leak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 1998; 27 606-613
- 21 Mirich D, Wright K C, Wallace S, Yoshioka T, Lawrence D D, Charnsangavej C, Gianturco C. Percutaneously Placed Endovascular Grafts for Aortic Aneurysms: Feasibility Study. Radiology. 1989; 170 1033-1037
- 22 Boudghene F P, Sapoval M, Bonneau M, LeBlanche A-F, Lavaste F C, Michel J-B. Abdominal aortic aneurysms in sheep: Prevention of rupture with endoluminal stent-grafts. Radiology. 1998; 206 447-454
- 23 Hölzenbein T J, Kretschmer G, Dorffner R, Turnher S, Sandner D, Minar E, Lammer J, Polterauer P. Endovascular management of “endoleaks” after transluminal infrarenal abdominal aneurysm repair. Eur J Vasc Endovasc Surg. 1998; 16 208-217
- 24 Alimi Y S, Chakfe N, Rivoal E, Slimane K K, Valerio N, Riepe G, Kretz J-G, Juhan C. Rupture of an abdominal aortic aneurysm after endovascular graft placement and aneurysm size reduction. J Vasc Surg. 1998; 28 178-183
- 25 Boudghene F, Anidjar S, Allaire E, Osborne-Pellegrin M, Bigot J-M, Michel J-B. Endovascular grafting in elastase-induced experimental aortic aneurysms in dogs: Feasibility and preliminary results. JVIR. 1993; 4 497-504
- 26 Hagen B, Harnoss B-M, Trabhardt S, Ladeburg M, Fuhrmann H, Franck C. Self-expandable macroporous Nitinol stents for transfemoral exclusion of aortic aneurysms in Dogs: Preliminary results. Cardiovasc Intervent Radiol. 1993; 16 339-342
- 27 Piquet P, Rolland P-H, Bartoli J-M, Tranier P, Moulin G, Mercier C. Tantalum-Dacron coknit stent for endovascular treatment of aortic aneurysms: A preliminary experimental study. J Vasc Surg. 1994; 19 698-706
- 28 Dolmatch B L, Tio F O, Li X D, Dong Y H. Patency and Tissue Response Related to Two Types of Polytetrafluoroethylene-Covered Stents in the Dog. JVIR. 1996; 7 641-649
- 29 White R A, Fogarty T J, Kopchok G E, Wilson E, Ayres B, Zalewski M, Donayre C E. Evaluation of a modular endovascular bifurcation prosthesis in a canine aortic aneurysm model. J Vasc Surg. 1996; 24 1034-1042
- 30 Palmaz J C. Review of polymeric graft materials for endovascular applications. JVIR. 1998; 9 7-13
- 31 Eton D, Warner D, Owens C, McClenic B, Cava R, Ofek B, Borhani M, Baraniewski H, Schuler J. Results of endoluminal grafting in an experimental aortic aneurysm model. J Vasc Surg. 1996; 23 819-831
- 32 Jordan W D, Sampson L K, Iyer S, Anderson P G, Lyle K, Brown R J, Luo J, Roubin G S. Abdominal aortic aneurysm repair via percutaneous endovascular stenting in the swine model. The American Surgeon. 1998; 64 1070-1073
- 33 Marty B, Dirsch O, von Segesser L K, Schneider J, Turina M. Die Reaktion der Gefäßwand auf mikroporöse endovaskuläre Prothesen. VASA. 1997; 26 33-38
- 34 Palmaz J C, Tio F O, Laborde J C, Clem M, Rivera F J, Murphy K D, Encarnacion C E. Use of stents covered with polytetrafluoroethylene in experimental abdominal aortic aneurysm. JVIR. 1995; 6 879-885
- 35 White R A, Kopchock G E, Zalewski M, Ayres B, Wilson E, de Virgilio C, Donayre C E. Comparison of the deployment and healing of thin- walled expanded PTFE stented grafts and covered stents. Ann Vasc Surg. 1996; 10 336-346
- 36 Sprague E A, Luo J, Palmaz J C. Human aortic endothelial cell migration onto stent surfaces under static and flow conditions. JVIR. 1997; 8 83-92
- 37 Vogt K C, Brunkwall J, Malina M, Ivancev K, Lindblad B, Risberg B, Schroeder T V. The use of intravascular ultrasound as control proce-dure for the deployment of endovascular stented grafts. Eur J Vasc Endovasc Surg. 1997; 13 592-596
- 38 White R A, Donayre C E, Kopchok G, Walot I, Wilson E P, de Virgilio C. Intravascular ultrasound: The ultimate tool for abdominal aortic aneurysm assessment and endovascular graft delivery. J Endovasc Surg. 1997; 4 45-55
Priv. Doz. Dr. Michael B. Pitton
Klinik für Radiologie, Universitätskliniken
Langenbeckstraße 1
55101 Mainz
Phone: + 49-6131-172019
Fax: + 49-6131-176633