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EndoAnchors in abdominal aortic endografts : in-vitro and clinical outcome

Vermeulen, J.J.M. (2018) EndoAnchors in abdominal aortic endografts : in-vitro and clinical outcome.

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Abstract:The main challenge of an endovascular aneurysm repair (EVAR) procedure to treat an abdominal aortic aneurysm (AAA) is fixation of the endograft in the aortic neck. Inaccurate fixation can cause complications, such as type IA endoleak, endograft migration, thrombosis, risk of rupture and need for reintervention. The Heli-FX EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) ensures endograft fixation and seal in the infrarenal aortic neck by penetrating both the endograft’s fabric and the aortic wall during EVAR. Despite the good outcomes of EndoAnchor usage, endoleaks are detected in 22.2% of the patients during follow-up. Furthermore, penetration and configuration of the EndoAnchors may influence the clinical outcome. Therefore, the aim of this thesis was to investigate the effect of the positioning and penetration depth of EndoAnchors with the focus on proximal fixation on the occurrence of endoleaks and migration. A clinical study on the sustainability of individual EndoAnchors was performed. Measurements were performed on CT data of patients which were treated therapeutically with EndoAnchors for type IA endoleaks. Afterwards, clinical information on applied EndoAnchor configurations was used to create a measurement protocol and an in-vitro measurement setup was developed. This setup was used to provide a validated environment to test the effect of the configuration of EndoAnchor deployment on the sensitivity of endograft migration. The follow-up study demonstrated that 97.4% of the initially good implanted EndoAnchors remained good at a median follow-up of 13 months. The in-vitro study showed that the endograft remained sensitive to migration, when there is no circumferential EndoAnchor deployment. The distance between EndoAnchors and EndoAnchor deployment below each other demonstrated to favourably influence the migration resistance. Overall, positioning and penetrating of EndoAnchors demonstrated to have an important effect on the occurrence of migration and the durability of individual EndoAnchors. Good deployed EndoAnchors have an excellent sustainability over time. Furthermore, EndoAnchors generate larger migration resistance when deployed circumferential or close to or below each other. Future research should focus on the effect of EndoAnchors on migration behaviour in different endografts and environments which mimic challenging aortic necks.
Item Type:Essay (Master)
Clients:
St. Antonius Hospital, Nieuwegein, The Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/75309
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