%0 Journal Article
%T In Vitro Quantification of Gutter Formation and Chimney Graft Compression in Chimney EVAR Stent
%A Cornelis H. Slump
%A Erik Groot Jebbink
%A Esm谷 J. Donselaar
%A Jean-Paul P. M. de Vries
%A Jorrit T. Boersen
%A Michel M. P. J. Reijnen
%A Simon P. Overeem
%J Journal of Endovascular Therapy
%@ 1545-1550
%D 2018
%R 10.1177/1526602818762399
%X Purpose: To assess the dynamic behavior of chimney grafts during the cardiac cycle. Methods: Three chimney endovascular aneurysm repair (EVAR) stent-graft configurations (Endurant and Advanta V12, Endurant and Viabahn, and Endurant and BeGraft) were placed in silicone aneurysm models and subjected to physiologic flow. Electrocardiography (ECG)-gated contrast-enhanced computed tomography was used to visualize geometric changes during the cardiac cycle. Endograft and chimney graft surface, gutter volume, chimney graft angulation over the center lumen line, and the D-ratio (the ratio between the lengths of the major and minor axes) were independently assessed by 2 observers at 10 time points in the cardiac cycle. Results: Both gutter volumes and chimney graft geometry changed significantly during the cardiac cycle in all 3 configurations (p<0.001). Gutters and endoleaks were observed in all configurations. The largest gutter volume (232.8 mm3) and change in volume (20.7 mm3) between systole and diastole were observed in the Endurant-Advanta configuration. These values were 2.7- and 3.0-fold higher, respectively, compared to the Endurant-Viabahn configuration and 1.7- and 1.6-fold higher as observed in the Endurant-BeGraft configuration. The Endurant-Viabahn configuration had the highest D-ratio (right, 1.26每1.35; left, 1.33每1.48), while the Endurant-BeGraft configuration had the lowest (right, 1.11每1.17; left, 1.08每1.15). Assessment of the interobserver variability showed a high correlation (intraclass correlation >0.935) between measurements. Conclusion: Gutter volumes and stent compression are dynamic phenomena that reshape during the cardiac cycle. Compelling differences were observed during the cardiac cycle in all configurations, with the self-expanding (Endurant每Viabahn) chimney EVAR configurations having smaller gutters and less variation in gutter volume during the cardiac cycle yet more stent compression without affecting the chimney graft surface
%K abdominal aortic aneurysm
%K aneurysm diameter
%K aneurysm model
%K cardiac cycle
%K chimney graft
%K endograft
%K dynamic computed tomography
%K ECG-gated computed tomography
%K endoleak
%K endovascular aneurysm repair
%K flow model
%K gutter
%K in vitro study
%K self-expanding stent-graft
%K stent compression
%K stent-graft
%K volume
%U https://journals.sagepub.com/doi/full/10.1177/1526602818762399