Fixation of infrarenal aortic stent-grafts using laparoscopic banding - Anexperimental study in pigs

Purpose: to test whether a laparoscopically-placed external band around the infrarenal aorta could stop vessel dilatation and prevent stent-graft deta chment from the aortic wall. Methods: in 13 growing pigs Gianturco-based stent-grafts were placed in the infrarenal aorta. In eight pigs, an external PTFE band (1 cm width) was pl aced laparoscopically around the infrarenal aorta. The remaining five pigs served as controls. Angiographic aortic diameters were measured: (1) at the most distal renal artery; (2) 1.5 cm further distally; (3) at the middle o f the stent-graft; and (4) below the stent-graft, 1 cm above the aortic bif urcation. Results: at a median follow-up of 16 weeks the pigs in the control group (n = 5) and in the banded group (n = 7) increased their weight from 24 kg to 107 kg and 23 to 83 kg, respectively. In the control group, aortic dimensio ns increased by approximately 40% at all levels. In the banded group, aorti c dimensions were unchanged at levels 2 and 3, but increased significantly at levels 1 and 4 (i.e. above and below the stent-graft). In the control gr oup all stent-grafts detached causing a proximal perigraft leakage. No deta chment or proximal perigraft leak was observed in the banded group. Conclusion: a laparoscopically placed external band around the infrarenal a orta of growing pigs seems to counteract the vessel dilatation and thereby provides a stable fixation of self-expandable stent-grafts.