Endoluminal treatment of ruptured abdominal aortic aneurysm with small intestinal submucosa sandwich endografts: A pilot study in sheep

Katsuyuki Yamada, Dusan Pavcnik, Barry Uchida, Hans A. Timmermans, Christopher Corless, Qiang (Michael) Yin, Koichiro Yamakado, Joong Wha Park, Josef Rosch, Frederick Keller, Morio Sato, Ryusaku Yamada

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)99-105
Number of pages7
JournalCardioVascular and Interventional Radiology
Volume24
Issue number2
DOIs
StatePublished - 2001

Fingerprint

Aortic Rupture
Abdominal Aortic Aneurysm
Sheep
Stents
Aneurysm
Rupture
Endoleak
Aortography
Neointima
Balloon Angioplasty
Paraplegia
Aortic Valve Stenosis
Therapeutics
Aorta
Dilatation
Autopsy
Spinal Cord
Thrombosis

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Endoluminal treatment of ruptured abdominal aortic aneurysm with small intestinal submucosa sandwich endografts : A pilot study in sheep. / Yamada, Katsuyuki; Pavcnik, Dusan; Uchida, Barry; Timmermans, Hans A.; Corless, Christopher; Yin, Qiang (Michael); Yamakado, Koichiro; Wha Park, Joong; Rosch, Josef; Keller, Frederick; Sato, Morio; Yamada, Ryusaku.

In: CardioVascular and Interventional Radiology, Vol. 24, No. 2, 2001, p. 99-105.

Research output: Contribution to journalArticle

Yamada, Katsuyuki ; Pavcnik, Dusan ; Uchida, Barry ; Timmermans, Hans A. ; Corless, Christopher ; Yin, Qiang (Michael) ; Yamakado, Koichiro ; Wha Park, Joong ; Rosch, Josef ; Keller, Frederick ; Sato, Morio ; Yamada, Ryusaku. / Endoluminal treatment of ruptured abdominal aortic aneurysm with small intestinal submucosa sandwich endografts : A pilot study in sheep. In: CardioVascular and Interventional Radiology. 2001 ; Vol. 24, No. 2. pp. 99-105.
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AU - Yamada, Katsuyuki

AU - Pavcnik, Dusan

AU - Uchida, Barry

AU - Timmermans, Hans A.

AU - Corless, Christopher

AU - Yin, Qiang (Michael)

AU - Yamakado, Koichiro

AU - Wha Park, Joong

AU - Rosch, Josef

AU - Keller, Frederick

AU - Sato, Morio

AU - Yamada, Ryusaku

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AB - 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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KW - Endovascular grafts

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