Published 4 issues per year
ISSN Print: 1050-6934
ISSN Online: 1940-4379
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Intra-Operative Fenestration of Stent Grafts: A Note of Caution Based upon Preliminary In Vitro Observations
ABSTRACT
Intra-operative fenestrations of stent grafts make more frail and elderly patients amenable to endovascular surgery but require further assessment of the viability of currently used experimental techniques. Four types of polyester fabrics currently employed in stent grafts were exposed in vitro to various protocols of fenestration: cutting, trocaring, and cantering. The resulting fenestrations were examined by gross observation, light microscopy, and scanning electron microscopy. Blunt fenestration by scissors and sharp penetration led to unpredictable apertures, impairment of the integrity of the grafts, and damage to the filaments. The fenestrations were more likely to extend in the woven fabrics, whereas the knitted fabrics were more resistant to fraying. The use of the electric cautery demonstrated the ability to create a fenestration by simultaneously perforating/cutting and edge sealing. Any safe fenestration requires a perforating method that ensures the sealing of the edge of the graft material with a well-controlled diameter. A preoperative fenestration can be tolerated, but there are risks of damage to the stent grafts when reloading the device. More elegant methods of preoperative fenestration, particularly in situ retrograde laser fenestration, are in development and deserve clinical validation.
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Wang Fujun, Li Chaojing, Wang Lu, Li Cong, Li Yuling, Lin Jing, Jing Zaiping, Douglas Graeham, Nutley Mark, Guidoin Robert, Flared textile cuff to be apposed on the proximal sealing zone in fenestrated stent-grafts, Textile Research Journal, 84, 3, 2014. Crossref
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Lin Jing, Parikh Niraj, Udgiri Naval, Wang Shaoxia, Miller Daniel F., Li Chaojing, Panneton Jean, Nutley Mark, Zhang Ze, Huang Yunfan, Lu Jun, Zhang Jingyi, Wang Lu, Guidoin Robert, Laser Fenestration of Aortic Stent-Grafts Followed by Noncompliant vs Cutting Balloon Dilation: A Scanning Electron Microscopy Study, Journal of Endovascular Therapy, 25, 3, 2018. Crossref
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XiaoHui Ma, Li Wei, Wei Guo, XiaoPing Liu, Xin Jia, Hongpeng Zhang, Lijun Wang, Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery, Vascular, 27, 2, 2019. Crossref
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Guidoin Robert, Wang Lu, Douville Yvan, Towards Mutuality in the Canada-China Relationship: The Experience of the Department of Surgery at Laval University since the 1980s, Frontiers of Education in China, 10, 3, 2015. Crossref
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Guidoin Robert, Lin Jing, Nutley Mark, Panneton Jean, Wang Lu, Zhang Ze, Commentary: Honing the Technique of In Situ Stent-Graft Fenestration, Journal of Endovascular Therapy, 28, 1, 2021. Crossref
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Lin Jing, Rodriguez Limael E., Nutley Mark, Jun Lu, Mao Ying, Parikh Niraj, Alie-Cusson Fanny, Zhang Ze, Wang Lu, Panneton Jean M., Guidoin Robert, Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts, Journal of Endovascular Therapy, 28, 2, 2021. Crossref
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Qin Jinbao, Zhao Zhen, Wang Ruihua, Ye Kaichuang, Li Weimin, Liu Xiaobing, Liu Guang, Cui Chaoyi, Shi Huihua, Peng Zhiyou, Yuan Fukang, Yang Xinrui, Lu Min, Huang Xintian, Jiang Mier, Wang Xin, Yin Minyi, Lu Xinwu, In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair, Journal of the American Heart Association, 6, 4, 2017. Crossref