The Proximal Fixation Strength of Modern EVAR Grafts in a Short Aneurysm Neck. An In Vitro Study

ObjectivesThe study aims to measure the strength of the proximal fixation of endografts in short and long necks.DesignThree types of endografts were compared: Gore Excluder®, Vascutek Anaconda® and Medtronic Endurant®.Materials and methodsThe proximal part of the stent grafts was inserted in bovine arteries and the graft was then attached to a tensile testing machine. The force to obtain dislodgement (DF) from the aorta was recorded for each graft at proximal seal lengths of 10 and 15 mm.ResultsThe median DF (interquartile range, IQR) for the Excluder, the Anaconda and the Endurant with a seal length of 15 mm was: 11.8 (10.5–12.0) N, 20.8 (18.0–30.1) N and 10.7 (10.4–11.3) N. With the shorter proximal seal of 10 mm, DF was, respectively: 6.0 (4.5–6.6) N, 17.0 (11.2–36.6) N and 6.4 (6.1–12.0) N.ConclusionsThe proximal fixation of the Anaconda is superior to the Excluder and the Endurant at short necks of 10 and 15 mm in an experimental set-up. There is a statistically significant decrease of proximal fixation for the Excluder stent graft, when decreasing the length of the proximal neck from 15 to 10 mm.