| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 2993320 | Journal of Vascular Surgery | 2011 | 7 Pages |
BackgroundThe absence of incorporation between endoprosthesis (EP) and the arterial wall may lead to device migration and endoleaks around the stent graft. Alternatives have been tested aiming to improve this incorporation. Fibrin glue is used in many operating procedures promoting adhesion and tissue regeneration; however, its use to improve EP incorporation by arteries is unknown.ObjectiveThe objective of this study was to analyze dislodgement forces needed to extract the EPs implanted in pig aorta, compare different oversizing and fibrin glue injections, and to analyze histologic changes among groups.MethodsStraight EPs were implanted in the thoracic aorta of pigs using 10% oversizing plus fibrin glue in the interface between the EP and the artery (group 1), using 20% oversizing (group 2), and 10% oversizing (group 3). Fourteen days after the implant, the animals were killed to enable biomechanical analysis of the EP and to verify histologic changes of the aortic wall and its interface with the EP.ResultsGroup 1 showed a dislodgement force of 21.9 ± 5.3 Newton (N) being higher than the other groups and statistically significant when compared to group 3 (15.6 ± 3.6N), P = .003%. Group 2 had a higher dislodgement force and statistically more significant than group 3 (19.5 ± 7.8N). Histologic analysis showed tissue reaction with inflammatory cells and fibroblasts higher in group 1 and group 2 compared to group 3.ConclusionThis study reports a large animal survival model of thoracic aortic stent graft placement by testing the impact of fibrin glue on EP incorporation. Compared to oversizing alone, fibrin glue placed between the stent graft and the arterial wall increases EP incorporation. Additional studies are needed to determine the potential utility of fibrin glue in the setting of human arterial endografts.
Clinical RelevanceThe incorporation of stent grafts never occurs and migration is a common problem. The EP resource fixation is oversizing, which has been empirically determined to be between 10% and 30%. In this article, biomechanical studies provided an evaluation about the oversizing and the forces for displacement of the EP. Moreover, successful initiatives have been done to improve the incorporation of the stent grafts. Our study used fibrin glue to improve the incorporation and fixation of stent grafts. Fibrin glue applied to the interface of the EP/aorta promoted better fixation of EPs, induced a more intense inflammatory reaction, and could be a very promising alternative in the development of new materials.
