A Study of Pullout Forces of the Components of Modular Multi-manufacturer Hybrid Endografts Used for Aortic Aneurysm Repair

ObjectivesAorto-iliac angulations may be challenging for modular stent-graft systems (SGSs) from a single manufacturer. This study aims to define the pullout forces (POFs) of SGSs derived from the same (non-hybrid) or different manufacturers (hybrid).MethodsThe POFs were tested in a vertical position in air and 5% albumin. We studied the POFs between legs from Anaconda (Vascutek®), Excluder (Gore®), Talent (Medtronic®) and Zenith (Cook®) with the contralateral limb of bifurcated aortic bodies from Zenith (12 mm), Anaconda and Excluder.ResultsFor non-hybrid SGSs, the POFs decreased in the following order: Anaconda (11.2 ± 0.6 N), Talent (6.25 ± 0.6 N), Zenith (3.5 ± 0.01 N) and Excluder (2.5 ± 0.5 N). The Zenith body with the Anaconda limb (15 mm) registered the greatest POF (13.083 ± 0.821 N); the Zenith and Excluder bodies combined with the Excluder limb (16 mm) registered the weakest POFs (2.397 ± 0.22 N and 2.500 ± 0.479 N, respectively). The Zenith body combined with the Excluder limb (16 mm) had a POF similar to the Zenith non-hybrid; combined with Talent 14 mm and Anaconda limb exhibited POFs greater than the Zenith non-hybrid system. For the limb-to-limb POFs, the greatest was registered for the Anaconda limb, 13 mm within a 12-mm extension for 40-mm overlaps (23.06 ± 0.480 N); the weakest POFs were recorded for the Excluder limbs at 30-mm overlaps (1.09 ± 0.167 N and 1.11 ± 0.250 N).ConclusionsThe hybrid SGSs performed as well as or better than the non-hybrid systems, and should be considered for clinical testing in patients whose unique anatomy warrants the flexibility that the use of hybrids provides.