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Rovas G, Bikia V, Stergiopulos N. Design and computational optimization of compliance-matching aortic grafts. Front Bioeng Biotechnol 2023; 11:1179174. [PMID: 37456727 PMCID: PMC10341153 DOI: 10.3389/fbioe.2023.1179174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction: Synthetic vascular grafts have been widely used in clinical practice for aortic replacement surgery. Despite their high rates of surgical success, they remain significantly less compliant than the native aorta, resulting in a phenomenon called compliance mismatch. This incompatibility of elastic properties may cause serious post-operative complications, including hypertension and myocardial hypertrophy. Methods: To mitigate the risk for these complications, we designed a multi-layer compliance-matching stent-graft, that we optimized computationally using finite element analysis, and subsequently evaluated in vitro. Results: We found that our compliance-matching grafts attained the distensibility of healthy human aortas, including those of young adults, thereby significantly exceeding the distensibility of gold-standard grafts. The compliant grafts maintained their properties in a wide range of conditions that are expected after the implantation. Furthermore, the computational model predicted the graft radius with enough accuracy to allow computational optimization to be performed effectively. Conclusion: Compliance-matching grafts may offer a valuable improvement over existing prostheses and they could potentially mitigate the risk for post-operative complications attributed to excessive graft stiffness.
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Vahabli E, Mann J, Heidari BS, Lawrence‐Brown M, Norman P, Jansen S, Pardo EDJ, Doyle B. The Technological Advancement to Engineer Next-Generation Stent-Grafts: Design, Material, and Fabrication Techniques. Adv Healthc Mater 2022; 11:e2200271. [PMID: 35481675 DOI: 10.1002/adhm.202200271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2022] [Indexed: 12/12/2022]
Abstract
Endovascular treatment of aortic disorders has gained wide acceptance due to reduced physiological burden to the patient compared to open surgery, and ongoing stent-graft evolution has made aortic repair an option for patients with more complex anatomies. To date, commercial stent-grafts are typically developed from established production techniques with simple design structures and limited material ranges. Despite the numerous updated versions of stent-grafts by manufacturers, the reoccurrence of device-related complications raises questions about whether the current manfacturing methods are technically able to eliminate these problems. The technology trend to produce efficient medical devices, including stent-grafts and all similar implants, should eventually change direction to advanced manufacturing techniques. It is expected that through recent advancements, especially the emergence of 4D-printing and smart materials, unprecedented features can be defined for cardiovascular medical implants, like shape change and remote battery-free self-monitoring. 4D-printing technology promises adaptive functionality, a highly desirable feature enabling printed cardiovascular implants to physically transform with time to perform a programmed task. This review provides a thorough assessment of the established technologies for existing stent-grafts and provides technical commentaries on known failure modes. They then discuss the future of advanced technologies and the efforts needed to produce next-generation endovascular implants.
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Affiliation(s)
- Ebrahim Vahabli
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - James Mann
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - Behzad Shiroud Heidari
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
| | | | - Paul Norman
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- Medical School The University of Western Australia Perth 6009 Australia
| | - Shirley Jansen
- Curtin Medical School Curtin University Perth WA 6102 Australia
- Department of Vascular and Endovascular Surgery Sir Charles Gairdner Hospital Perth WA 6009 Australia
- Heart and Vascular Research Institute Harry Perkins Medical Research Institute Perth WA 6009 Australia
| | - Elena de Juan Pardo
- School of Engineering The University of Western Australia Perth 6009 Australia
- School of Mechanical Medical and Process Engineering Queensland University of Technology Brisbane Queensland 4059 Australia
- T3mPLATE Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth WA 6009 Australia
| | - Barry Doyle
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
- British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh Edinburgh EH16 4TJ UK
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Lin J, Nutley M, Li C, Douglas G, Du J, Zhang Z, Douville Y, Guidoin R, Wang L. Innovative textile structures designed to prevent type III endoleaks in endovascular stent-grafts. Artif Organs 2020; 45:278-288. [PMID: 32969519 DOI: 10.1111/aor.13819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
The damage caused to the fabric of endovascular stent-grafts most often occurs at the contact zones between the fabrics where they are attached to the apices of Z-shaped stents as a result of normal physiologic pulsatile movement within angulated vessels in vivo. Although design improvements were made over the years, the risks were not fully eliminated even with the newer M-shaped stent reconfiguration. In this study, we proposed to create and manufacture a novel fabric for stent-grafts with specifically designed reinforced zones to enhance resistance to fabric abrasion. These reinforced zones are set at the vicinity of the apices of the Z-shaped stents and between two adjacent Z-shaped stents where folding and pleating are commonly observed to occur in angulated vessels. Three innovative weaving structures with two different types of yarns and two controls were designed and prepared. Two commonly used commercial devices supported, respectively, with ringed stents, and Z-shaped stents were selected as the references for comparison. Textile structures including thickness, water permeability, mechanical properties, (more specifically tensile and bursting stress, as well as fatigue simulation) were tested on all fabrics. Compared to commercially available plain weaves, the fabrics with locally reinforced zones showed improved mechanical characteristics and fatigue resistant properties. A fabric designed with specifically reinforced zones has now clearly been shown to effectively reduce the abrasion caused by the apices of Z-shaped stents. However, further optimization may still be possible.
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Affiliation(s)
- Jing Lin
- Key Laboratory of Textile Science and Technology of Ministry of Education, Donghua University, Shanghai, China
| | - Mark Nutley
- Division of Vascular Surgery and Department of Diagnostic Imaging, Peter Lougheed Centre, University of Calgary, Calgary, AB, Canada
| | - Chaojing Li
- Key Laboratory of Textile Science and Technology of Ministry of Education, Donghua University, Shanghai, China
| | - Graeham Douglas
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Jia Du
- Key Laboratory of Textile Science and Technology of Ministry of Education, Donghua University, Shanghai, China
| | - Ze Zhang
- Department of Surgery, Université Laval, Centre de Recherche du CHU de Québec - Université Laval, Quebec, QC, Canada
| | - Yvan Douville
- Department of Surgery, Université Laval, Centre de Recherche du CHU de Québec - Université Laval, Quebec, QC, Canada
| | - Robert Guidoin
- Department of Surgery, Université Laval, Centre de Recherche du CHU de Québec - Université Laval, Quebec, QC, Canada
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education, Donghua University, Shanghai, China
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Guidoin R, Lin J, Nutley M, Panneton J, Wang L, Zhang Z. Commentary: Honing the Technique of In Situ Stent-Graft Fenestration. J Endovasc Ther 2020; 28:53-55. [PMID: 32907451 DOI: 10.1177/1526602820952412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert Guidoin
- Department of Surgery, Faculty of Medicine, Université Laval and Centre de Recherche du CHU, Quebec, Quebec, Canada
| | - Jing Lin
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Mark Nutley
- Division of Vascular Surgery and Department of Diagnostic Imaging, Peter Longheed Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jean Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Ze Zhang
- Department of Surgery, Faculty of Medicine, Université Laval and Centre de Recherche du CHU, Quebec, Quebec, Canada
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Li C, Mao J, Li Q, Wang F, Jiao Y, Zhang Z, Guidoin R, Wang L. Long-term anticoagulation and selective cells adhesion surface via combination of covalent grafting and layer by layer assembly. Biomed Mater 2019; 14:065012. [DOI: 10.1088/1748-605x/ab452b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fatimi A. Chitosan-based embolizing hydrogel for the treatment of endoleaks after endovascular aneurysm repair. INT J POLYM MATER PO 2019. [DOI: 10.1080/00914037.2018.1525729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ahmed Fatimi
- Department of Chemistry, Facuté Polydisciplinaire, Sultan Moulay Slimane University, Béni-Mellal, Morocco
- Laboratory of Biological Engineering, Faculté des Sciences et Techniques, Sultan Moulay Slimane University, Béni-Mellal, Morocco
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Affiliation(s)
- Julio C. Palmaz
- The University of Texas Health Science Center, San Antonio, TX, USA
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Lejay A, Monnot A, Georg Y, Colvard B, Thaveau F, Geny B, Chakfé N. Pathology of graft and stent-graft infections: Lessons learned from examination of explant materials. Semin Vasc Surg 2017; 30:70-74. [DOI: 10.1053/j.semvascsurg.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McWilliams RG, Chan TY, Smout J, Torella F, Fisher RK. Endovascular Repair of Type IIIb Endoleak With the Amplatzer Septal Occluder. J Endovasc Ther 2016; 24:262-264. [PMID: 27974603 DOI: 10.1177/1526602816683645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the successful treatment of a type IIIb endoleak with an Amplatzer Septal Occluder. CASE REPORT A 76-year-old man was found to have a type IIIb endoleak in the proximal body component of a fenestrated graft at 4-year surveillance imaging; the leak was associated with rapid aneurysm growth. The anatomy of the graft and position of the fabric defect precluded treatment by relining with a secondary endograft. The defect was demonstrated with catheter angiography, sized with an angioplasty balloon, and repaired using an Amplatzer Septal Occluder. Follow-up imaging at 6 months showed no endoleak and marked reduction in the aneurysm size. CONCLUSION The Amplatzer Septal Occluder may be considered as an option for managing type IIIb endoleaks.
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Affiliation(s)
| | - Tze Yuan Chan
- 1 Radiology Department, Royal Liverpool University Hospital, Liverpool, UK
| | - Jonathan Smout
- 2 Liverpool Vascular and Endovascular Service, Liverpool, UK
| | | | - Robert K Fisher
- 2 Liverpool Vascular and Endovascular Service, Liverpool, UK
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Paprottka KJ, Paprottka PM, Reiser MF, Waggershauser T. Comparative study of the corrosion behavior of peripheral stents in an accelerated corrosion model: experimental in vitro study of 28 metallic vascular endoprostheses. Diagn Interv Radiol 2016; 21:403-9. [PMID: 26268301 DOI: 10.5152/dir.2015.15062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Clinical cases of stent-fractures show that corrosion behavior might play a role in these fractures. Implanted in vivo, especially in combination with other implanted foreign materials, these metallic products are exposed to special conditions, which can cause a process of corrosion. Here, we aimed to test the corrosion potential of stents made of different materials in an in vitro setting. METHODS A total of 28 peripheral stents of different materials (nitinol, cobalt-chromium-nickel, tantalum, V4A) and surface treatments (electropolish, mechanical polish, no polish) were tested in vitro. Corrosion was accelerated by applying a constant voltage of 3.5 V and amperage of 1.16 mA in 0.9% NaCl. RESULTS Nitinol stents showed the lowest susceptibility to corrosion and the longest period without damage. The Memotherm II® (BARD Angiomed®) was the only stent that showed neither macroscopic nor microscopic damages. The worst performing material was cobalt-chromium-nickel, which showed corrosion damages about ten times earlier compared to nitinol. Considering the reasons for termination of the test, nitinol stents primarily showed length deficits, while V4A and tantalum stents showed fractures. Cobalt-chromium-nickel stents had multiple fractures or a complete lysis in equal proportions. When placed in direct contact, nitinol stents showed best corrosion resistance, regardless of what material they were combined with. In terms of polishing treatments, electropolished stents performed the best, mechanical-polished stents and those without polishing treatment followed. CONCLUSION The analysis of corrosion behavior may be useful to select the right stent fulfilling the individual needs of the patient within a large number of different stents.
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Affiliation(s)
- Karolin J Paprottka
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
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The Potential Role of Graphene in Developing the Next Generation of Endomaterials. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3180954. [PMID: 28025640 PMCID: PMC5153502 DOI: 10.1155/2016/3180954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 10/24/2016] [Indexed: 01/10/2023]
Abstract
Graphene is the first 2-dimensional material and possesses a plethora of original properties. Graphene and its derivatives have exhibited a great potential in a number of fields, both medical and nonmedical. The aim of this review is to set the theoretical basis for further research in developing graphene-based endovascular materials. An extensive search was performed in medical and bioengineering literature. Published data on other carbon materials, as well as limited data from medical use of graphene, are promising. Graphene is a promising future material for developing novel endovascular materials. Certain issues as biocompatibility, biotoxicity, and biostability should be explored further.
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12
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Murphy EH, Johnson ED, Arko FR. Device-Specific Resistance to in Vivo Displacement of Stent-Grafts Implanted with Maximum Iliac Fixation. J Endovasc Ther 2016; 14:585-92. [PMID: 17696636 DOI: 10.1177/152660280701400422] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To compare the in vivo device-specific downward displacement force of various externally supported endografts implanted with maximum iliac fixation. Methods: Twenty female sheep had aneurysms created with a graft patch in the infrarenal aorta. In 12 animals, a fully supported modular bifurcated stent-graft [AneuRx (n=4), Talent (n=4), or Zenith (n=4)] was deployed; in the other 8, a bifurcated aortic graft was surgically anastomosed to the infrarenal aorta. All grafts were displaced in vivo by applying downward traction to a guidewire brought out both femoral arteries. The peak force to cause initial stent-graft migration or disruption of the sutured anastomosis was recorded and compared. Results: There was no difference in animal size, aortic neck diameter or length, aneurysm size, or iliac artery diameter for animals receiving the AneuRx, Talent, or Zenith stent-grafts and those undergoing surgical repair. The mean length of iliac fixation was 31.0±0.3 mm, 30.8±0.5 mm, and 31.3±0.6 mm for the AneuRx, Talent, and Zenith devices, respectively (p=NS). Peak force to initiate migration was 30.2=5.5 N (range 25–38) for the AneuRx, 44.8±5.5 N (range 40–53) for the Talent, 46.7±5.4 N (range 38–55) for the Zenith, and 40.6±7.5 N (range 31–50) for the surgical anastomosis (p=0.01). There was no difference detected in the peak force to initiate migration between the suprarenally affixed Talent and Zenith stent-grafts and the surgical anastomosis (p=0.55). Conclusion: Devices with a suprarenal component require significantly greater force to cause downward displacement compared to infrarenal devices. The force required to displace a suprarenal device with maximal iliac fixation was equivalent to the force required to disrupt a surgical anastomosis.
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Affiliation(s)
- Erin H Murphy
- Division of Vascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390-9157, USA
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Grinding and polishing instead of sectioning for the tissue samples with a graft: Implications for light and electron microscopy. Micron 2016; 85:1-7. [DOI: 10.1016/j.micron.2016.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/22/2022]
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Lequoy P, Savoji H, Saoudi B, Bertrand-Grenier A, Wertheimer MR, De Crescenzo G, Soulez G, Lerouge S. In Vitro and Pilot In Vivo Evaluation of a Bioactive Coating for Stent Grafts Based on Chondroitin Sulfate and Epidermal Growth Factor. J Vasc Interv Radiol 2016; 27:753-760.e3. [DOI: 10.1016/j.jvir.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents. MATERIALS 2016; 9:ma9020113. [PMID: 28787913 PMCID: PMC5456472 DOI: 10.3390/ma9020113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.
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Takeuchi M, Kuratani T, Miyagawa S, Shirakawa Y, Shimamura K, Kin K, Yoshida T, Arai Y, Hoashi T, Teramoto N, Hirakawa K, Kawaguchi N, Sawa Y. Tissue-engineered stent-graft integrates with aortic wall by recruiting host tissue into graft scaffold. J Thorac Cardiovasc Surg 2014; 148:1719-25. [DOI: 10.1016/j.jtcvs.2014.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/18/2014] [Accepted: 04/03/2014] [Indexed: 01/22/2023]
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Jones SM, Vallabhaneni SR, McWilliams RG, Naik J, Nicholas T, Fisher RK. Type IIIb Endoleak Is an Important Cause of Failure Following Endovascular Aneurysm Repair. J Endovasc Ther 2014; 21:723-7. [DOI: 10.1583/13-4616mr.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Multidetector CT findings of complications of surgical and endovascular treatment of aortic aneurysms. Radiol Clin North Am 2014; 52:961-89. [PMID: 25173654 DOI: 10.1016/j.rcl.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aortic aneurysms remain a significant problem in the population, and there is a concerted effort to identify, define, image, and treat these conditions to ultimately improve outcomes. The rapid development of diagnostic modalities, operative strategies, and endovascular techniques within the realm of this aortic disease has transformed the field and broadened the spectrum of patients that can be treated with minimally invasive techniques. This investigation has a broad spectrum of normal expected findings that must be differentiated from early or late complications in which intervention is required. In this article, normal and abnormal postoperative and post-TEVAR/EVAR MDCT findings are described.
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Guidoin R, Zhang Z, Douville Y, Nutley M. Commentary: nitinol stent designs need to adhere to the 3Bs: biofunctionality, biodurability, and biocompatibility. J Endovasc Ther 2014; 21:240-2. [PMID: 24754283 DOI: 10.1583/13-4530c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robert Guidoin
- 1 Department of Surgery, Laval University, Quebec, Canada
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Lequoy P, Liberelle B, De Crescenzo G, Lerouge S. Additive Benefits of Chondroitin Sulfate and Oriented Tethered Epidermal Growth Factor for Vascular Smooth Muscle Cell Survival. Macromol Biosci 2014; 14:720-30. [DOI: 10.1002/mabi.201300443] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/09/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Pauline Lequoy
- Research Centre; Centre Hospitalier de l'Université de Montréal (CRCHUM); 900 rue Saint Denis Montreal QC, Canada H2X 0A9
- Department of Mechanical Engineering; École de technologie supérieure (ÉTS); 1100 boul. Notre-Dame Ouest Montréal, QC Canada H3C 1K3
| | - Benoît Liberelle
- Department of Chemical Engineering; École Polytechnique de Montréal; P.O. Box 6079, succ. Centre-Ville Montréal, QC Canada H3C 3A7
| | - Gregory De Crescenzo
- Department of Chemical Engineering; École Polytechnique de Montréal; P.O. Box 6079, succ. Centre-Ville Montréal, QC Canada H3C 3A7
| | - Sophie Lerouge
- Research Centre; Centre Hospitalier de l'Université de Montréal (CRCHUM); 900 rue Saint Denis Montreal QC, Canada H2X 0A9
- Department of Mechanical Engineering; École de technologie supérieure (ÉTS); 1100 boul. Notre-Dame Ouest Montréal, QC Canada H3C 1K3
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Sincos IR, da Silva ES, Belczak SQ, Baptista Sincos APW, de Lourdes Higuchi M, Gornati V, Otoch JP, Aun R. Histologic analysis of stent graft oversizing in the thoracic aorta. J Vasc Surg 2013; 58:1644-1651.e4. [DOI: 10.1016/j.jvs.2013.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/29/2022]
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Lin J, Wang L, Guidoin R, Nutley M, Song G, Zhang Z, Du J, Douville Y. Stent fabric fatigue of grafts supported by Z-stents versus ringed stents: An in vitro buckling test. J Biomater Appl 2013; 28:965-77. [DOI: 10.1177/0885328213488228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stent-grafts externally fitted with a Z-shaped stents were compared to devices fitted with ringed stents in an in vitro oscillating fatigue machine at 200 cycles per minute and a pressure of 360 mmHg for scheduled durations of up to 1 week. The devices fitted with Z-stents showed a considerably lower endurance limit to buckling compared to the controls. The contact between the apexes of adjacent Z-stents resulted in significant damage to the textile scaffolds and polyester fibers due to the sharp angle of the Z-stents. The ringed stents did not cause any fraying in the textile scaffolds.
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Affiliation(s)
- Jing Lin
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Robert Guidoin
- Department of Surgery, Laval University and Québec Biomaterials Institute, Quebec City, QC, Canada
| | - Mark Nutley
- Section of Vascular Surgery, Peter Lougheed Health Center, University of Calgary, Calgary, AB, Canada
| | - Ge Song
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Ze Zhang
- Department of Surgery, Laval University and Québec Biomaterials Institute, Quebec City, QC, Canada
| | - Jia Du
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Yvan Douville
- Department of Surgery, Laval University and Québec Biomaterials Institute, Quebec City, QC, Canada
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Drynda A, Seibt J, Hassel T, Bach FW, Peuster M. Biocompatibility of fluoride-coated magnesium-calcium alloys with optimized degradation kinetics in a subcutaneous mouse model. J Biomed Mater Res A 2012; 101:33-43. [DOI: 10.1002/jbm.a.34300] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 05/22/2012] [Indexed: 11/11/2022]
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Veger HTC, Hedeman Joosten PP, Thoma SR, Visser MJT. Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature. Vascular 2012; 21:10-3. [PMID: 22619381 DOI: 10.1258/vasc.2011.cr0294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infection of endovascular abdominal aneurysm stent grafts is an uncommon but known complication. Inoculation with bacteria of the endovascular abdominal aneurysm stent graft during the actual implantation, in the periprocedural hospitalization or later due to an aortoenteric fistula, has been described in the literature. We report a case of endovascular abdominal aortic aneurysm stent graft infection occurring 40 months after implantation in a patient doing well up to an episode of urosepsis. In conclusion, we postulate that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in a higher susceptibility to episodes of bacteremia than prosthetic vascular grafts inserted during open repair. We therefore consider the administration of prophylactic antibiotics in patients with endovascular stent grafts during periods with a likelihood of bacteremia.
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Affiliation(s)
- H T C Veger
- Department of Vascular Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden.
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25
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Charbonneau C, Ruiz JC, Lequoy P, Hébert MJ, De Crescenzo G, Wertheimer MR, Lerouge S. Chondroitin sulfate and epidermal growth factor immobilization after plasma polymerization: a versatile anti-apoptotic coating to promote healing around stent grafts. Macromol Biosci 2012; 12:812-21. [PMID: 22457238 DOI: 10.1002/mabi.201100447] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/03/2012] [Indexed: 11/09/2022]
Abstract
Bioactive coatings constitute an interesting approach to enhance healing around implants, such as stent-grafts used in endovascular aneurysm repair. Three different plasma techniques, namely NH₃ plasma functionalization and atmospheric- or low-pressure plasma polymerization, are compared to create amino groups and covalently bind CS and EGF bioactive molecules on PET. The latter presents the greatest potential. CS + EGF coating is shown to strongly decrease cell apoptosis and cell depletion in serum-free medium, while increasing cell growth compared to unmodified PET. This versatile biomimetic coating holds promise in promoting vascular repair around stent-grafts, where resistance to apoptosis is a key issue.
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Affiliation(s)
- Cindy Charbonneau
- Research Centre, Centre Hospitalier de l'Université de Montréal-CRCHUM, 1560 Rue Sherbrooke Est, Montréal-Qc H2L 4M1, Canada
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26
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Uhlenbrock AGD, Wintzer C, Imig H, Morlock M. Fluid transfer as a mechanism leading to endotension. Med Eng Phys 2010; 32:914-20. [DOI: 10.1016/j.medengphy.2010.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 04/15/2010] [Accepted: 06/27/2010] [Indexed: 11/25/2022]
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27
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Zhong H, Matsui O, Xu K, Ogi T, Sanada JI, Okamoto Y, Tabata Y, Takuwa Y. Gene transduction into aortic wall using plasmid-loaded cationized gelatin hydrogel-coated polyester stent graft. J Vasc Surg 2009; 50:1433-43. [DOI: 10.1016/j.jvs.2009.07.071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 07/13/2009] [Accepted: 07/13/2009] [Indexed: 01/28/2023]
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28
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Zarins CK, Taylor CA. Endovascular device design in the future: transformation from trial and error to computational design. J Endovasc Ther 2009; 16 Suppl 1:I12-21. [PMID: 19317584 DOI: 10.1583/08-2640.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular devices have been designed by trial and error, with bench and animal testing followed by human clinical trials to determine whether the devices are safe and effective. Despite remarkable advances over the past 15 years, there are persistent concerns regarding the long-term durability of endovascular devices. This may be due to deficiencies in device design, which has lagged behind other industries in adopting computational methods that are now routinely used to design, develop, and test new aircraft and automobiles. Similar computational design and failure mode simulations that evaluate performance under stress conditions have not been widely applied in the development of endovascular devices. Advances in medical imaging and computational modeling now allow simulation of physiological conditions in patient-specific 3-dimensional vascular models, which can provide a framework to design and test the next generation of endovascular devices. This modeling will allow the prospective design of devices that can withstand the force variations in the cardiovascular system that occur during bending, coughing, and varying degrees of exercise, as well as the extremes encountered during sudden impact in contact sports. Utilization of computational design methodology that takes into consideration the physiology of the cardiovascular system will improve future endovascular devices so that they are safer and more effective and durable.
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Affiliation(s)
- Christopher K Zarins
- Stanford University School of Medicine and School of Engineering, Stanford, California, USA.
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29
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Guidoin R, Peirano MAM, Barone HD, McGregor R, Marinov GR, Merhi Y, Zhang Z, Bertoni H, Guzman R, Rouabhia M, Douville Y. Analysis of explanted Latecba modular stent-grafts deployed transrenally to repair AAAs with short necks in 29 dogs. ACTA ACUST UNITED AC 2009; 37:23-31. [PMID: 19140034 DOI: 10.1080/10731190802664650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-nine modular stent-grafts deployed transrenally to repair AAAs with short necks in dogs were harvested at autopsy of the animals after scheduled durations of implantations of 10 days, one month, three months, and six months. Analyses of the explanted devices included non-destructive techniques such as gross observations, X-rays CT scan, IVUS and angioscopy. Further to appropriate dissection, histological investigations were carried out by means of scanning electron microscopy (SEM) and light microscopy. All the 29 specimens were extensively encapsulated with fibrous tissues but the fibrous capsule was thin in six of them; four capsules were ulcerated. The X-rays confirmed the stability of the devices that were still straight (12), slightly bent (12) or bent (4). The modules were misaligned in only one case. IVUS and angioscopy confirmed the patency of all the stent-grafts with thin internal capsules both proximally and distally with variable capsulation in the mid-section of the grafts. The left renal artery orifices were found to be patent at dissection with no obstruction to flow. The luminal flow surface of the stent-grafts was smooth and glistening proximally and distally containing endothelial like cells and vasa-vasorum. Poor healing was noted in the aneurysm area. Transrenal deployment of this modular stent-graft is feasible and gave excellent results with regard to biofunctionality and biocompatibility. The device proved to be safe and efficient.
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Affiliation(s)
- Robert Guidoin
- Quebec Biomaterials Institute, CHUQ and Department of Surgery, Laval University, Quebec, QC, Canada.
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30
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Corbett TJ, Callanan A, Morris LG, Doyle BJ, Grace PA, Kavanagh EG, McGloughlin TM. A review of the in vivo and in vitro biomechanical behavior and performance of postoperative abdominal aortic aneurysms and implanted stent-grafts. J Endovasc Ther 2008; 15:468-84. [PMID: 18729555 DOI: 10.1583/08-2370.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms has generated widespread interest since the procedure was first introduced two decades ago. It is frequently performed in patients who suffer from substantial comorbidities that may render them unsuitable for traditional open surgical repair. Although this minimally invasive technique substantially reduces operative risk, recovery time, and anesthesia usage in these patients, the endovascular method has been prone to a number of failure mechanisms not encountered with the open surgical method. Based on long-term results of second- and third-generation devices that are currently becoming available, this study sought to identify the most serious failure mechanisms, which may have a starting point in the morphological changes in the aneurysm and stent-graft. To investigate the "behavior" of the aneurysm after stent-graft repair, i.e., how its length, angulation, and diameter change, we utilized state-of-the-art ex vivo methods, which researchers worldwide are now using to recreate these failure modes.
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Affiliation(s)
- Timothy J Corbett
- Centre for Applied Biomedical Engineering Research, MSSI, Department of Mechanical and Aeronautical Engineering, University of Limerick, Ireland
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31
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Guidoin R, Peirano MAM, Barone HD, Douville Y, Zhang Z, Guzman R, Bertoni H, Merhi Y, Marinov GR, McGregor R, Zhang H, Chappard D, Dionne G, Deng X. Transrenal deployment of a modular stent graft to repair AAAs with short necks: experiments in dogs. ACTA ACUST UNITED AC 2008; 36:310-39. [PMID: 18649168 DOI: 10.1080/10731190802239016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Severely angulated (> 60 degrees ) or short (< 15 mm) proximal necks remain significant anatomical limitations for endovascular stent-graft repairs for abdominal aortic aneurysms. Ensuring proper proximal fixation of the stent-graft to the host artery without the short-or long-term risks of endoleak or migration represents a particular technical challenge for these anatomical circumstances. An innovative balloon expandable stent combined with a weft-knitted prosthesis was specifically designed for these situations by modelling the stent to the neck anatomy without overdistension or potential barotrauma allowing better incorporation of the device. The Latecba stent-graft consists of a 2 parts modular design. The first one, Module A, is deployed at the transrenal level and consists of a Palmaz type stent whose first half is bare and second half is sutured to a crimped weft-knitted polyester graft whose distal end holds a constriction. The second Module B is a non-crimped weft-knitted graft attached to 2 stainless steel stents. The first stent is entirely contained in the proximal textile tube, allowing fixation to module A. The second stent, which is left uncovered over the distal third, ensures proper fixation of the stent-graft distally. Following the creation of a prosthetic aneurysm in the infrarenal aorta in 32 dogs, 29 received the Latecba stent-graft for scheduled durations of 10 days, 1 month, 3 months and 6 months. Proper deployment of the stent-grafts was achieved without difficulty. All 29 animals survived and the devices were all patent at sacrifice. No device defects or migrations were observed and the stent-grafts proved to be efficient in this setting to exclude the aneurysm. Analyses of the explanted devices (gross observations, RX, CT scan, IVUS, angioscopy) confirmed the stability of this modular stent-graft. Further on-going clinical investigations are warranted to validate this concept before this stent-graft becomes commercially available without any restriction.
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Affiliation(s)
- Robert Guidoin
- Quebec Biomaterials Institute, CHUQ and Department of Surgery, Laval University, Quebec, Canada.
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32
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Lange C, Aasland JK, Ødegård A, Myhre HO. The Durability of Evar — What are the Evidence and Implications on Follow-Up? Scand J Surg 2008; 97:205-12. [DOI: 10.1177/145749690809700227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of follow-up investigations, and how complications and secondary procedures influence cost-effectiveness. Material and Methods: 263 patients were treated by EVAR from february 1995-february 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program. Results: There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well. Conclusions: Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This follow-up regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.
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Affiliation(s)
- C. Lange
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
| | - J. K. Aasland
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
| | - A. Ødegård
- Department of Radiology, St. Olavs Hospital, University Hospital of Trondheim
| | - H. O. Myhre
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
- Department of Circulation Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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33
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Murphy EH, Johnson ED, Arko FR. Device-Specific Resistance to in Vivo Displacement of Stent-grafts Implanted With Maximum Iliac Fixation. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[585:drtivd]2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Charbonneau C, Gautrot JE, Hébert MJ, Zhu XX, Lerouge S. Chondroitin-4-Sulfate: A Bioactive Macromolecule to Foster Vascular Healing around Stent-Grafts after Endovascular Aneurysm Repair. Macromol Biosci 2007; 7:746-52. [PMID: 17457946 DOI: 10.1002/mabi.200700008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Deficient healing after endovascular aneurysm repair with a stent-graft is thought to be related to pro-apoptotic environment in abdominal aortic aneurysms and inertness of graft materials. We developed a bioactive coating containing chondroitin-4-sulfate and assessed its potential to improve cell adhesion, viability and resistance to apoptosis on PET surfaces. Coatings of collagen type I and CS were prepared and characterized by DMMB, FT-IR, DSC, SEM and contact angle goniometry. Preliminary cell culture experiments with vascular smooth muscle cells showed increased adhesion and viability in serum-free medium on CS-coated surfaces compared to control PET films.
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Affiliation(s)
- Cindy Charbonneau
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Est, Montréal, QC, Canada H2L 4M1
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35
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Lerouge S, Major A, Girault-Lauriault PL, Raymond MA, Laplante P, Soulez G, Mwale F, Wertheimer MR, Hébert MJ. Nitrogen-rich coatings for promoting healing around stent-grafts after endovascular aneurysm repair. Biomaterials 2007; 28:1209-17. [PMID: 17129601 DOI: 10.1016/j.biomaterials.2006.10.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 10/26/2006] [Indexed: 11/22/2022]
Abstract
Complications following endovascular aneurysm repair (EVAR) are related to deficient healing around the stent-graft (SG). New generations of SG with surface properties that foster vascular repair could overcome this limitation. Our goal was to evaluate the potential of a new nitrogen-rich plasma-polymerised biomaterial, designated PPE:N, as an external coating for polyethylene terephtalate (PET)- or polytetrafluoro-ethylene (PTFE)-based SGs, to promote healing around the implant. Thin PPE:N coatings were deposited on PET and PTFE films. Then, adhesion, growth, migration and resistance to apoptosis of vascular smooth muscle cells (VSMCs) and fibroblasts, as well as myofibroblast differentiation, were assessed in vitro. In another experimental group, chondroitin sulphate (CS), a newly described mediator of vascular repair, was added to normal culture medium, to search for possible additional benefit. PPE:N-coatings, especially on PET, increased and accelerated cell adhesion and growth, compared with control PET and with standard polystyrene culture plates (PCP). PPE:N was also found to increase the resistance to apoptosis in VSMC, an important finding as aneurysms are characterised by VMSC depletion caused by a pro-apoptotic phenotype. Addition of CS in solution further increased migration and resistance to apoptosis. In conclusion, PPE:N-coating and/or CS could promote vascular repair around SGs following EVAR.
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Affiliation(s)
- Sophie Lerouge
- Research Center, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
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