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EndoEx: An Updated Bench Model Testing For An EVAR Explantation Tool
Rishik S. Puppala
1, Brandon Look Fong
1, Maham Rahimi
2.
1Texas A&M University, Houston, TX, USA,
2Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: Endovascular abdominal aortic aneurysm repair (EVAR) and its recent advances have improved the outcomes of abdominal aortic aneurysm (AAA) repair with lower morbidity and mortality in the short term. However, endovascular stent grafts are associated with two major complications including graft infection (10%) and endoleaks (68%) with sac expansion which both require explantation1. Graft explantation is necessary because of infection or failure of endosalvage of endoleak which are both associated with high morbidity and mortality. Currently, there are no available instruments to safely remove endografts, and the need to minimize damage to the aortic wall during EVAR explantation.
METHODS: The testing environment aimed to simulate the explant environment as close to the surgical procedure. A testing apparatus using linear actuators simulates the shear forces experienced during explantation and automates the testing process while holding constant the angle, length, and duration for each trial. 5% agar gel was used to simulate the endothelium. The testing apparatus and agar gel were used to simulate multiple trials and the damage from each simulated endothelium was analyzed for shaved surface area, representing endothelial damage. Gel selection criteria maintained uniformity between samples by excluding shrunken or irregular gels.
RESULTS:Standardizing our testing trials allowed us to create uniform pressure tests for each of the agar wells for the EndoEx device and syringe. There were 14 trials conducted on agar for the EndoEx device and 14 trials conducted on agar for the syringe. The EndoEx mean surface area lost was 0 cm2. The standard error for the trials was 0 cm2. Conversely, the syringe mean surface area lost was 3.97 cm2. The standard error for the trials was 0.05 cm2. The findings demonstrate a significant difference between the two test groups (t-test: 1.04E-31).
CONCLUSIONS: Our study has shown the effectiveness of using the EndoEx device compared to the current syringe method. Explantation procedures can drastically reduce the damage that occurs to the endothelial lining of the abdominal aorta. The drastic reduction can lead to improvements in the morbidity and mortality rates. Limitations during the testing revolve around tissue testing, which is currently underway to test the device’s effectiveness in tissue.
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