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The Journal of Cardiovascular Surgery 2002 December;43(6):857-63

language: English

Stent jail of the renal arteries in stent graft exclusion of AAA. An in vitro study of 3 different stent types

Gawenda M., Winter S., Jaschke G., Brunkwall J.

Vascular Centre University of Cologne Cologne, Germany


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Background. The suc­cess of endo­lu­mi­nal ­stent ­grafts (­ELG) is crit­i­cal­ly depen­dent on ­secure prox­i­mal fix­a­tion of ­the ­graft. Different ­types of ­stent ­grafts ­with uncov­ered prox­i­mal por­tions ­for trans­re­nal fix­a­tion ­are obtain­able. The ­present in ­vitro ­study ­was ­designed to elu­ci­date ­how ­the ­flow param­e­ters ­were ­altered by ­stent ­jail of ­the ­renal arter­ies ­with ­respect to dif­fer­ent ­stent ­design.
Methods. The experi­ments ­were per­formed in an in ­vitro pul­sa­tile cir­cu­la­tion mod­el. An aor­tic seg­ment ­with bilat­er­al ­side branch­es (­like ­renal arter­ies) con­struct­ed of an ePTFE ­graft ­was per­fused in ­the cir­cu­la­tion mod­el. The ­flow meas­ure­ments ­were ­based on ­the ultra­sound tran­sit-­time meth­od. By var­y­ing ­the fre­quen­cy ­from 30 to 100 ­b­pm ­the ­flow param­e­ters ­were ­altered ­and record­ed con­tin­u­ous­ly. Renal ­stent jail­ing ­was car­ried ­out ­using dif­fer­ent ­stent ­types: Gianturco-Z-Stent, Palmaz-Stent, Powerlink Endologix™.
Results. The ­flow in ­the aor­tic mod­el ­increased ­from 1100 ml ­per min­ute to 3330 ml ­per min­ute depend­ing on ­the ­pump fre­quen­cy. In ­the con­trol ­group with­out ­stent ­jail ­the ­renal ­flow ­was meas­ured ­between 240 ml ­per min­ute up to 810 ml ­per min­ute. The ­ratio of ­renal ­flow ­was ­between 0.22 ­and 0.24 of ­the aor­tic ­flow. In ­the Palmaz ­group ­the ­ratio ­was ­between 0.21 ­and 0.24, in ­the Gianturco ­group ­between 0.23 ­and 0.25, ­and in ­the Powerlink ­group ­between 0.24 ­and 0.25 (­unpaired-“t”-­test: n.s.).
Conclusions. The cov­er­ing of ­the ­renal arter­ies ­and/ or super­i­or mes­en­ter­ic ­artery in ­case of ­long ­bared prox­i­mal ­stent rais­es ­the ques­tion wheth­er ­the ­stent ­jail ­may ­result in ­flow reduc­tion in ­the arter­ies cov­ered or ­not. The ­present in ­vitro ­study dem­on­strat­ed ­that ­the ­flow in ­the ­renal arter­ies is ­not ­decreased by ­these ­stent ­jails.

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