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CardioVascular and Interventional Radiology

, Volume 24, Issue 2, pp 99–105 | Cite as

Endoluminal Treatment of Ruptured Abdominal Aortic Aneurysm with Small Intestinal Submucosa Sandwich Endografts: A Pilot Study in Sheep

  • Katsuyuki Yamada
  • Dusan Pavcnik
  • Barry T. Uchida
  • Hans A. Timmermans
  • Christopher L. Corless
  • Qiang Yin
  • Koichiro Yamakado
  • Joong Wha Park
  • Josef Rösch
  • Frederick S. Keller
  • Morio Sato
  • Ryusaku Yamada
Laboratory Investigations

Abstract

Purpose

To evaluate efficacy of small intestinal submucosa (SIS) Sandwich endografts for the treatment of acute rupture of abdominal aortic aneurysms (AAA) and to explore the short-term reaction of the aorta to this material.

Methods

In eight adult sheep, an infrarenal AAA was created transluminally by dilation of a short Palmaz stent. In six sheep, the aneurysm was then ruptured by overdilation of the stent with a large angioplasty balloon. Two sheep with AAAs that were not ruptured served as controls. A SIS Sandwich endograft, consisting of a Z stent frame with 5 bodies and covered inside and out with SIS, was used to exclude the ruptured and non-ruptured AAAs. Follow-up aortography was done immediately after the procedure and before sacrifice at 4, 8, or 12 weeks. Autopsy and histologic studies followed.

Results

Endograft placement was successful in all eight sheep. Both ruptured and non-ruptured AAAs were successfully excluded. Three animals with AAA rupture developed hind leg paralysis due to compromise of the arterial supply to the lower spinal cord and were sacrificed 1 day after the procedure. In five animals, three with rupture and two controls, follow-up aortograms revealed no aortic stenoses and no perigraft leaks. Gross and histologic studies revealed incorporation of the endografts into the aortic wall with replacement of SIS by dense neointima that was completely endothelialized in areas where the endograft was in direct contact with the aortic wall. In central portions of the endograft, in contact with the thrombosed aneurysm, endothelialization was incomplete even at 12 weeks.

Conclusion

The SIS Sandwich endografts effectively excluded simple AAAs and ruptured AAAs. They were rapidly incorporated into the aortic wall. A detailed long-term study is warranted.

Key words

Aortic aneurysm Aneurysm rupture Endoluminal treatment Endovascular grafts Biomaterials small intestinal submucosa Animal models 

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References

  1. 1.
    Blum U, Voshage G, Lammer J, Beyersdorf F, Tollner D, Kretschmer G, Spillner G, Polterauer P, Nagel G, Holzenbein T (1997) Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med 336:13–20PubMedCrossRefGoogle Scholar
  2. 2.
    May J, White GH, Waugh R, Stephen MS, Chaufourt X, Yut W, Harris JP (1999) Endovascular treatment of abdominal aortic aneurysms. Cardiovasc Surg 7:484–490PubMedCrossRefGoogle Scholar
  3. 3.
    Chuter TA, Reilly LM, Faruqi RM, Kerlan RB, Sawhney R, Canto CJ, La Berge JM, Wilson MW, Gordon RL, Wall SD, Rapp J, Messina LM (2000) Endovascular aneurysm repairs in high-risk patients. J Vasc Surg 31:122–133PubMedCrossRefGoogle Scholar
  4. 4.
    Katzen BT, Becker GJ, Benenati JF, Zemal G (1998) Stent grafts for aortic aneurysms: The next interventional challenge. Am J Cardiol 81:33E–43EPubMedCrossRefGoogle Scholar
  5. 5.
    Yusuf SW, Whitaker SC, Chuter TA, Wenham PW, Hopkinson BR (1994) Emergency endovascular repair of leaking aortic aneurysm. Lancet 344:1645PubMedCrossRefGoogle Scholar
  6. 6.
    Ohki T, Veith FJ, Sanchez LA, Cynamon J, Lipsitz EC, Wain RA, Morgan JA, Zhen L, Suggs WD, Lyon RT (1999) Endovascular graft repair of ruptured aortoiliac aneurysms. J Am Coll Surg 189:102–112PubMedCrossRefGoogle Scholar
  7. 7.
    Greenberg R, Resch T, Nyman U, Lindh M, Brunkwall J, Brunkwall P, Malina M, Koul B, Lindblad B, Ivancev K (2000) Endovascular repair of descending thoracic aortic aneurysms: An early experience with intermediate-term follow-up. J Vasc Surg 31:147–156PubMedCrossRefGoogle Scholar
  8. 8.
    Pfammatter T, Lacbat M, Leung D, Leung DA, von Smekal A, Blum U (2000) Endoluminal treatment of symptomatic or ruptured abdominal aortic aneurysm. (abstract) J Vasc Interv Radiol 11:219CrossRefGoogle Scholar
  9. 9.
    Williams DM, Andrews JC, Chee SS, Marx MV, Abrams GD (1994) Canine model of acute aortic rupture: Treatment with percutaneous delivery of a covered Z stent: Work in progress. J Vasc Interv Radiol 5:797–803PubMedCrossRefGoogle Scholar
  10. 10.
    Hallisey MJ (1997) A transluminally created abdominal aortic aneurysm model. J Vasc Interv Radiol 8:305–312PubMedCrossRefGoogle Scholar
  11. 11.
    Badylak SF (1993) Small intestinal submucosa (SIS): A biomaterial conducive to smart tissue remodeling. In: Bell E (ed) Tissue Engineering: Current Perspectives. Burkhauser, Cambridge, MA, pp 179–189Google Scholar
  12. 12.
    Badylak SF, Coffey AC, Lantz GC, Tacker WA, Geddes LA (1994) Comparison of the resistance to infection of intestinal submucosa arterial autografts versus polytetrafluoroethylene arterial prostheses in a dog model: J Vasc Surg 19:465–472PubMedCrossRefGoogle Scholar
  13. 13.
    Badylak SF, Lantz GC, Coffey AC, Geddes LA (1989) Small intestinal submucosa as a large diameter vascular graft in the dog. J Surg Res 47:74–80PubMedCrossRefGoogle Scholar
  14. 14.
    Lantz GC, Badylak SF, Coffey AC, Geddes LA, Sandusky GE (1992) Small intestine submucosa as a superior vena cava graft in the dog. J Surg Res 53:175–181PubMedCrossRefGoogle Scholar
  15. 15.
    Lantz GC, Badylak SF, Hiles MC, Coffey AC, Geddes LA, Kokini K, Sandusky GE, Morff RJ (1993) Small intestinal submucosa as a vascular graft: A review. J Invest Surg 6:297–310PubMedCrossRefGoogle Scholar
  16. 16.
    Johansen K, Swedenborg J (1986) Ruptured abdominal aortic aneurysm: A study of incidence and mortality. Br J Surg 73:101–103CrossRefGoogle Scholar
  17. 17.
    Johansen K, Kohler TR, Nicholls SC, Zierler RE, Clowes AW, Kazmers A (1991) Ruptured abdominal aortic aneurysm: The Harborview experience. J Vasc Surg 13:240–245PubMedCrossRefGoogle Scholar
  18. 18.
    Halpern VJ, Kline RG, D’Angelo AJ, Cohen JR (1997) Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms. J Vasc Surg 26:939–945PubMedCrossRefGoogle Scholar
  19. 19.
    Hardman DT, Fisher CM, Patel MI, Neale M, Chambers J, Lane R, Appleberg M (1996) Ruptured abdominal aortic aneurysms: Who should be offered surgery? J Vasc Surg 23:123–139PubMedCrossRefGoogle Scholar
  20. 20.
    Harris KA, Ameli FM, Lally M, Provan JL, Johnston KW, Goldberg MR, Walker PM (1986) Abdominal aortic aneurysm resection in patients more than 80 years old. Surg Gynecol Obstet 162:536–538PubMedGoogle Scholar
  21. 21.
    Orend KH, Heymer B, Pamler RS, Hahn J, Sunder-Plassmann L (1996) Histomorphological examination of endoluminal stent grafting in the descending aorta in a sheep model. Thorac Cardiovasc Surg 44:132–135PubMedCrossRefGoogle Scholar
  22. 22.
    Gorin DR, Arbid EJ, D’Agostino R, Yucel EK, Solovay KS, LaMorte WW, Quist WC, Mulligan N, Menzoian JO (1997) A new generation endovascular graft for repair of abdominal aortic aneurysms. Am J Surg 173:159–164PubMedCrossRefGoogle Scholar
  23. 23.
    White GH, Yu W, May J, Waugh R, Chaufour X, Harris JP, Stephen MS (1997) Three-year experience with the White-Yu Endovascular GAD Graft for transluminal repair of aortic and iliac aneurysms. J Endovasc Surg 4:124–136PubMedCrossRefGoogle Scholar
  24. 24.
    Boudghene FP, Sapoval MR, Bonneau M, LeBlanche AF, Lavaste FC, Michel JB (1998) Abdominal aortic aneurysms in sheep: Prevention of rupture with endoluminal stent-grafts. Radiology 206:447–454PubMedGoogle Scholar
  25. 25.
    Olin JM, McCarthy TJ, Fugitani RM, Mueller MP, Yu W, Peterson R (1998) A sheep model of abdominal aortic aneurysms for evaluation of bifurcated endovascular grafts. (abstract) Am Ass Lab Anim Sci 37:105Google Scholar
  26. 26.
    Beygui RE, Kinney EV, Pelc LR, Krievins D, Whittemore J, Fogarty TJ, Zarins CK (1999) Prevention of spinal cord ischemia in an ovine model of abdominal aortic aneurysm treated with a self-expanding stent-graft. J Endovasc Surg 6:278–284PubMedCrossRefGoogle Scholar
  27. 27.
    Sauvage LR, Berger KE, Wood SJ, Yates SG 2nd, Smith JC, Mansfield PB (1974) Interspecies healing of porous arterial prostheses: Observations, 1960 to 1974. Arch Surg 109:698–705PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2001

Authors and Affiliations

  • Katsuyuki Yamada
    • 1
  • Dusan Pavcnik
    • 1
  • Barry T. Uchida
    • 1
  • Hans A. Timmermans
    • 1
  • Christopher L. Corless
    • 2
  • Qiang Yin
    • 3
  • Koichiro Yamakado
    • 1
  • Joong Wha Park
    • 1
  • Josef Rösch
    • 1
  • Frederick S. Keller
    • 1
  • Morio Sato
    • 4
  • Ryusaku Yamada
    • 5
  1. 1.Dotter Interventional Institute, Oregon Health Sciences UniversityPortlandUSA
  2. 2.Department of PathologyOregon Health Sciences UniversityPortlandUSA
  3. 3.Department of SurgeryOregon Health Sciences UniversityPortlandUSA
  4. 4.Department of RadiologyWakayama Medical CollegeWakayama-shi, WakayamaJapan
  5. 5.Department of RadiologyOsaka City University School of MedicineOsakaJapan

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