A New Modular Stent Graft to Reconstruct Aortic Arch

Abstract

Endovascular repair by stent graft has been developed as a safe and less-invasive treatment for descending thoracic and abdominal aortic diseases. In case of involvement of the aortic arch, the challenge in endovascular repair is to maintain blood flow to the brain and upper extremities. Several studies have been done trying to repair this difficult part of the aorta with different stent grafts, and we have developed a new stent-graft device for aortic arch reconstitution. We implanted the new device in canine models to test its feasibility. The new stent graft was composed of three components: parts I and II were both bifurcated, one with long, narrow limb and the other short and wide, and part III was a tubular component. Ten adult hybrid dogs were operated with the new stent-graft procedure, and eight were successfully implanted with the stent grafts. The technical success rate was 80% (8 of 10). Five dogs survived for 3 months without obvious cerebral, visceral or limb ischaemia. Autopsies showed that the implanted stent grafts were patent and the vital side branches of aortic arch were well preserved. Our study demonstrates that it is possible to reconstruct aortic arch with the new branched stent grafts. The advantage of this device is that it is modular, more adaptable and surgical bypass could be possibly avoided.