Device-Specific Resistance to in Vivo Displacement of Stent-Grafts Implanted with Maximum Iliac Fixation

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.