Conceptual Framework Development for a Double-Walled Aortic Stent-Graft to Manage Blood Pressure.

Abstract

A double-walled stent-graft (DWSG) design with a compressible gas layer was conceived with the goal of treating hypertension in patients receiving an aortic stent-graft. Early prototypes were developed to evaluate the design concept through static measurements from a finite element (FE) model and quasi-static inflation experiments, and through dynamic measurements from an in vitro flow loop and the three-element Windkessel model. The amount of gas in the gas layer and the properties of the flexible inner wall were the primary variables evaluated in this study. Properties of the inner wall had minimal effect on DWSG behavior, but increased gas charge led to increased fluid capacitance and larger reduction in peak and pulse pressures. In the flow loop, placement of the DWSG decreased pulse pressure by over 20% compared to a rigid stent-graft. Capacitance measurements were consistent across all methods, with the maximum capacitance estimated at 0.07 mL/mmHg for the largest gas charge in the 15 cm long prototype. Windkessel model predictions for in vivo performance of a DWSG placed in the aorta of a hypertensive patient showed pulse pressure reduction of 14% compared to a rigid stent-graft case, but pressures never returned to unstented values. These results indicate that the DWSG design has potential to be developed into a new treatment for hypertensive patients requiring an aortic intervention.