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

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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.

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Authors and Affiliations

  1. Dotter Interventional Institute, Oregon Health Sciences University, L342, 3181 SW Sam Jackson Park Road, 97201, Portland, OR, USA

    Katsuyuki Yamada, Dusan Pavcnik M.D., Ph.D., Barry T. Uchida, Hans A. Timmermans, Koichiro Yamakado, Joong Wha Park, Josef Rösch & Frederick S. Keller

  2. Department of Pathology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, 97201, Portland, OR, USA

    Christopher L. Corless

  3. Department of Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, 97201, Portland, OR, USA

    Qiang Yin

  4. Department of Radiology, Wakayama Medical College, 811 Banchi, Kimiidera, Wakayama-shi, Wakayama, 641-0012, Japan

    Morio Sato

  5. Department of Radiology, Osaka City University School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Ryusaku Yamada

Authors
  1. Katsuyuki Yamada
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Correspondence to Dusan Pavcnik M.D., Ph.D..

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Yamada, K., Pavcnik, D., Uchida, B.T. et al. Endoluminal Treatment of Ruptured Abdominal Aortic Aneurysm with Small Intestinal Submucosa Sandwich Endografts: A Pilot Study in Sheep. Cardiovasc Intervent Radiol 24, 99–105 (2001). https://doi.org/10.1007/s002700000400

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