Top

CardioVascular and Interventional Radiology

Published in:

01-10-2012 | Laboratory Investigation

Placement of Endovascular Stent across the Branching Arteries: Long-term Serial Evaluation of Stent-tissue Responses Overlying the Arterial Orifices in an Experimental Study

Authors: Young Il Kim, Jin Wook Chung, Hyun Beom Kim, Jae Hyung Park, Jeong Wook Seo, Hyo-Cheol Kim, Hwan Jun Jae, Whal Lee

Published in: CardioVascular and Interventional Radiology | Issue 5/2012

Abstract

Purpose

This study was designed to investigate the effects of stenting across the branching arteries on the patency and stent-tissue responses over the branching arterial orifices.

Methods

Thirteen dogs were observed after placing aortic stents across the celiac arteries (CA), superior mesenteric arteries (SMA), and renal arteries (RA). The animals were grouped according to stent types: large-cell group (n = 6) and small-cell group (n = 7). Angiography was performed to evaluate the branching artery patency at 2, 6, and 12 months after stent insertion, and the stent-tissue responses covering the orifices were evaluated on histopathologic examination.

Results

All branching arteries were patent on follow-up angiography; however, three patterns of stent-tissue responses over the orifices were observed: neointimal layering, bridging septa, and papillary hyperplasia. Although neointimal layering and bridging septa were evenly observed, severe papillary hyperplasia was more frequent at SMA and CA than RA. Four RA showed less than 50% ostial patency, and localized infarct was observed in six kidneys (24%). The ostial patency tended to decrease with small-cell stent during the follow-up period.

Conclusions

Various stent-tissue responses over the branching artery orifices are induced by the aortic stent covering the branching arteries and may not be easily detected by conventional angiography. Subclinical renal infarct also may occur despite patent renal angiography.

Sadat U, Boyle JR, Walsh SR et al (2008) Endovascular vs. open repair of acute abdominal aortic aneurysms–a systematic review and meta-analysis. J Vasc Surg 48:227–236PubMedCrossRef

Schumacher H, Eckstein HH, Kallinowski F et al (1997) Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery. J Endovasc Surg 4:39–44PubMedCrossRef

Bove PG, Long GW, Shanley CJ et al (2003) Transrenal fixation of endovascular stent-grafts for infrarenal aortic aneurysm repair: mid-term results. J Vasc Surg 37:938–942PubMedCrossRef

Marin ML, Parsons RE, Hollier LH et al (1998) Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms. J Vasc Surg 28:638–646PubMedCrossRef

MacIerewicz J, Walker SR, Vincent R et al (1999) Vascular Surgical Society of Great Britain and Ireland: perioperative renal function following endovascular repair of abdominal aortic aneurysms with suprarenal and infrarenal stents. Br J Surg 86:696PubMedCrossRef

Bove PG, Long GW, Zelenock GB et al (2000) Transrenal fixation of aortic stent grafts for the treatment of infrarenal aortic aneurysmal disease. J Vasc Surg 32:697–703PubMedCrossRef

Garber JC, Barbee RW, Bielitzki (2010) Guide for the care and use of laboratory animals, 8th edn. The National Academies Press, Washington

Dake MD, Kato N, Mitchell RS et al (1999) Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 340:1546–1552PubMedCrossRef

Grabenwoger M, Hutschala D, Ehrlich MP et al (2000) Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts. Ann Thorac Surg 69:441–445PubMedCrossRef

10.

Kramer SC, Seifarth H, Pamler R et al (2002) Renal infarction following endovascular aortic aneurysm repair: incidence and clinical consequences. J Endovasc Ther 9:98–102PubMedCrossRef

11.

Izzedine H, Koskas F, Cluzel P et al (2002) Renal function after aortic stent-grafting including coverage of renal arterial ostia. Am J Kidney Dis 39:730–736PubMedCrossRef

12.

Van Damme JP, Bonte J (1990) Vascular anatomy in abdominal surgery. Thieme Verlag, New York

13.

Burks JA Jr, Fairies PL, Gravereaux EC et al (2002) Endovascular repair of abdominal aortic aneurysms: stent-graft fixation across the visceral arteries. J Vasc Surg 35:109–113PubMed

14.

Bove PG, Long GW, Shanley CJ et al (2003) Transrenal fixation of endovascular stent-grafts for infrarenal aortic aneurysm repair: mid-term results. J Vasc Surg 37:938–942PubMedCrossRef

15.

Malina M, Lindh M, Ivancev K et al (1997) The effect of endovascular aortic stents placed across the renal arteries. Eur J Vasc Surg 13:207–213CrossRef

16.

Whitbread T, Birch P, Rogers S et al (1997) The effect of placing an aortic Wallstent across the renal artery origins in an animal model. Eur J Vasc Surg 13:154–158CrossRef

17.

Desgranges P, Hutin E, Kedzia C et al (1997) Aortic stents covering the renal arteries ostia: an animal study. J Vasc Interv Radiol 8:77–82PubMedCrossRef

18.

Birch PC, Start RD, Whitbread T et al (1999) The effects of crossing porcine renal artery ostia with various endovascular stents. Eur J Vasc Surg 17:185–190CrossRef

19.

Riesen S, Schmid V, Gaschen L et al (2002) Doppler measurement of splanchnic blood flow during digestion in unsedated normal dogs. Vet Radiol Ultrasound 43:554–560PubMedCrossRef

20.

Peters PJ, Reinhardt S (2006) The echocardiographic evaluation of intracardiac masses: a review. J Am Soc Echocardiogr 19:230–240PubMedCrossRef

21.

Liebeskind DS, Buljubasic N, Saver JL (2001) Cardioembolic stroke due to papillary fibroelastoma. J Stroke Cerebrovasc Dis 10:94–95PubMedCrossRef

22.

Sun Z, Allen YB, Nadkarni S et al (2008) CT virtual intravascular endoscopy in the visualization of fenestrated stent-grafts. J Endovasc Ther 15:42–51PubMedCrossRef

23.

Balderi A, Antonietti A, Pedrazzini F, Ferro L, Leotta L, Peano E, Grosso M (2010) Treatment of a hepatic artery aneurysm by endovascular exclusion using the multilayer carditis stent. Cardiovasc Intervent Radiol 33:1282–1286PubMedCrossRef

24.

Meyer C, Verrel F, Weyer G, Wilhelm K (2011) Endovascular management of complex renal artery aneurysms using the multilayer stent. Cardiovasc Intervent Radiol 34:637–641PubMedCrossRef

25.

Chocron S, Vaislic C, Kaili D, Bonneville JF (2011) Multilayer stents in the treatment of thoraco-abdominal residual type B dissection. Interact Cardiovasc Thorac Surg 12:1057–1059PubMedCrossRef

26.

Palmaz JC (1993) Inravascular stents: tissue-stent interactions and design considerations. AJR Am J Roentgenol 160:613–618PubMed

27.

Surowiec SM, Davies MG, Fegley AJ et al (2004) Relationship of proximal fixation to postoperative renal dysfunction in patients with normal serum creatinine concentration. J Vasc Surg 39:804–810PubMedCrossRef

28.

Alsac JM, Zarins CK, Heikkinen MA et al (2005) The impact of aortic endografts on renal function. J Vasc Surg 41:926–930PubMedCrossRef

29.

Walsh SR, Tang TY, Boyle JR (2008) Renal consequences of endovascular abdominal aortic aneurysm repair. J Endovasc Ther 15:73–82PubMedCrossRef

30.

O’Donnell ME, Sun Z, Winder EJ et al (2007) Suprarenal fixation of endovascular aortic stent grafts: assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology. J Vasc Surg 45:694–700PubMedCrossRef

31.

Kalliafas S, Travis SJ, Macierewicz J et al (2001) Intrarenal color duplex examination of aortic endograft patients with suprarenal stents. J Endovasc Ther 8:592–596PubMedCrossRef

32.

Böckler D, Krauss M, Mannsmann U et al (2003) Incidence of renal infarctions after endovascular AAA repair: relationship to infrarenal versus suprarenal fixation. J Endovasc Ther 10:1054–1060PubMedCrossRef

33.

Sun Z, Stevenson G (2005) Transrenal fixation of aortic stent-grafts; short to midterm effects on renal function: a systematic review. Radiology 240:65–72CrossRef

Title: Placement of Endovascular Stent across the Branching Arteries: Long-term Serial Evaluation of Stent-tissue Responses Overlying the Arterial Orifices in an Experimental Study
Authors: Young Il Kim
Jin Wook Chung
Hyun Beom Kim
Jae Hyung Park
Jeong Wook Seo
Hyo-Cheol Kim
Hwan Jun Jae
Whal Lee
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 5/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0243-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Placement of Endovascular Stent across the Branching Arteries: Long-term Serial Evaluation of Stent-tissue Responses Overlying the Arterial Orifices in an Experimental Study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2012

Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

Digital Ischemia and Consecutive Amputation After Emergency Transradial Cardiac Catheter Examination

Serum Gamma-Glutamyl-Transferase Independently Predicts Outcome After Transarterial Chemoembolization of Hepatocellular Carcinoma: External Validation

CT-Guided Percutaneous Biopsy of a Mass Lesion in the Upper Presacral Space: A Sacral Transneuroforaminal Approach

Portal Vein Embolization: What Do We Know?

Hepatic Toxicity After Radioembolization of the Liver Using 90Y-Microspheres: Sequential Lobar Versus Whole Liver Approach