Author/Editor		Yamada, Katsuyuki; Pavčnik, Dušan; Uchida, Barry T; Timmermans, Hans A; Corless, Christopher L; Yin, Qiang; Yamakado, Koichiro; Park, Joong Wha; Roesch, Josef; Keller, Frederick S
Title		Endoluminal treatment of ruptured abdominal aortic aneurysm with small intestinal submucosa Sandwich endografts: a pilot study in sheep
Type		članek
Source		Cardiovasc Intervent Radiol
Vol. and No.		Letnik 24
Publication year		2001
Volume		str. 99-105
Language		eng
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 histoiogic 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.
Descriptors		ANGIOPLASTY AORTIC ANEURYSM, ABDOMINAL AORTIC RUPTURE INTESTINAL MUCOSA INTESTINE, SMALL AUTOPSY BALLOON DILATATION DISEASE MODELS, ANIMAL FOLLOW-UP STUDIES SHEEP TREATMENT OUTCOME