D. Pavcnik et al., Bifurcated drum occluder endograft for treatment of abdominal aortic aneurysm: An experimental study in dogs, J VAS INT R, 12(3), 2001, pp. 359-364
PURPOSE: To evaluate a new, low profile, home-made, bifurcated drum occlude
r endograft (BDOEG), designed for percutaneous, transcatheter treatment of
abdominal aortic aneurysm (AAA).
MATERIALS AND METHODS: AAA was created in 10 dogs with over-dilated Palmaz
stents. To prevent back filling, the lumbar arteries, inferior mesenteric a
rtery, and common internal iliac arteries were embolized. The BDOEG was con
structed of a drum occluder device and two PTFE endografts. The drum device
consisted of a modified Z stent with Dacron stretched across and held with
in the ends of the stent, each with two 8 x 6-mm slits through which PTFE e
ndografts were delivered. The PTFE endografts were 8 mm in diameter and 9.5
cm in length. Preloaded, the BDOEG was delivered through a 10-F sheath fro
m both femoral arteries in a three-step procedure. All 10 animals were trea
ted with BDOEG. Aortography was performed immediately, 6 weeks, and 12 week
s after stent-graft placement. Five animals were killed at 6 weeks and five
were killed at 3 months. Gross and histologic evaluation was performed.
RESULTS: The infrarenal aortic diameters and both external iliac arteries r
anged from 8.0 mm to 10.3 mm (mean, 9.4 mm +/- 0.6) and from 5.2 mm to 6.8
mm (mean, 5.8 mm +/- 0.5), respectively. Creation of the AAA was successful
in all 10 dogs. AAA diameters ranged from 13.7 mm to 15.9 mm (mean, 14.9 m
m +/- 0.7). Complete exclusion of the AAA was achieved immediately after BD
OEG placement and aneurysms remained excluded without perigraft leak to the
time of killing in all 10 animals. There was a high incidence of aortoilia
c limb occlusion. Occlusion of 12 aortoiliac limbs (60%) caused by intimal
hyperplasia at the distal end of the endografts in iliac arteries developed
in nine animals (90%). In six animals (60%), one limb occluded and, in thr
ee animals (30%), there was occlusion of both limbs.
CONCLUSION: This study suggests a new approach for treatment of AAA. BDOEG
use reduces sheath size for endograft delivery and may eliminate the need f
or a surgical cut down on femoral arteries. Tapering of the iliac ends of e
ndografts to the size of the artery will be needed to prevent distal intima
l hyperplasia.