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Scanning Electron Microscope analysis of Ex-Vivo laser fenestration of Thoracic Endografts : Variables for optimal fenesterations?
Navalkishor Udgiri, MD1, Jing Lin, MSc2, Robert Guidoin3, Ze Zhang, PhD3, David Dexter, MD1, Xiaoning Guan, MSc2, Bin Li, MD3, Lu Wang, PhD2, Jean Panneton, MD1.
1EVMS, Norfolk, VA, USA, 2Key Laboratory of Textile Science and Technology Of Ministry of Education and College of Textiles, Shanghai, China, 3Department of Surgery Laval University, Quebec, QC, Canada.

Scanning Electron Microscope analysis of Ex-Vivo laser fenestration of Thoracic Endografts : Variables for optimal fenestrations ?
Introduction
Branched Thoracic Aortic stent-grafts represent a considerable breakthrough in complex Thoracic pathology . The delay in manufacturing customized devices and the limited availability of these devices out of clinical trials makes In-situ Laser Fenestration of Endografts an attractive option in emergent patients .
Methods
Three different thoracic stent-grafts; Cook Zenith TX2 (multifilament fabric), Medtronic Valiant (monofilament fabric) and Vascutek Anaconda (multifilament fabric) were subjected to laser fenestration ex-vivo with laser system in a physiological saline solution followed by dilatation with 8, 10 and 12 mm diameter balloons. The fenestrations were then observed for gross observation, light microscopy and Scanning Electron Microscopy . The length and area of fenestrations were recorded and studied.
Results
One hundred and eighty fenestrations were created using 1.7,2.0 and 2.3 mm laser fiber. The mean area of fenestration after 8, 10 and 12 mm balloon angioplasty for the endografts were 10, 10, 30 mm2 for Cook Zenith , 35.6, 51.8, 65.2mm2 for Valiant and 6.0, 9.9, 24.2 mm2 for Anaconda. There was significant difference in these areas between the grafts at 8mm(p<0.001) , 10mm(p=0.006) and 12mm balloons(p=0.007). Graft type also demonstrated a difference in longitudinal (warp) and lateral(weft) fabric tear . Longitudinal tear with 8,10,12mm balloon angioplasty for Cook Zenith was 4.6,6.2,2.3 mm, for Valiant was 3.2,4.8,3.7 mm and for Anaconda was 3.5,4.6,5.1mm respectively .Lateral tear with 8,10,12mm balloon angioplasty for Zenith was 2.5, 3.1 ,7.3 mm, for valiant was 6, 8, 3.7 mm and for Anaconda was 5.4, 7.1, 5.1 mm respectively .The Dispersion of the area and length of fenestration increased as the balloon diameter increased and they were more predictable with 8 mm balloon(fig1) .
Conclusion
Ex-Vivo Fenestration area and length was more predictable with 8 mm balloon, there was more dispersion with increasing balloon sizes. The area and length of fenestration was significantly different in different grafts under same conditions .These results should be able to guide us to obtain optimal In-Situ Fenesterations.


Figures 1: Dispersion of the measurements: area vs warp


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