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Abstract:

Aortic aneurysms and dissections are life threatening problems and pose significant management challenges. Open operative repair is associated with significant morbidity and mortality and this has prompted an increasing interest in endoluminal solutions. There are well known and potentially catastrophic complications associated with failure to achieve a seal proximally at the time of insertion and with dislocation of the prosthesis.

A technique to improve fixation of the prosthesis in patients with short aortic “necks” in open and endoluminal procedures would be to staple the prosthesis to the aortic wall. A stapler would only be of value, especially for endoluminal procedures, if it could achieve transmural fixation with only endoluminal access.

It became possible because of the stapler construction, containing staples made from memory-shaped metals, which can form the rings after discharge.

The technology was designed by Australian company Endogene Pty. Ltd. in Russian and Australian research laboratories.

The study was performed over 6 years in separate experiments on 7 adult mongrel male dogs (average weight 20 kg), 5 sheep (average weight 47 kg) and 12 pigs (average weight 68 kg). Access to abdominal aorta was obtained by central laparotomy, with the animals under general anaesthesia (sodium phentobarbital, 30 mg/kg).

The deployment of the new stapler technology for graft fixation inside of animal aorta was successfully performed. The time taken for the procedure i.e., from introduction of the stapler into the aorta to removal was less than one minute. Observation of the anastomosis revealed complete staple penetration of the aortic wall and ring formation of the individual staples. There was no evidence of unexpected damage to the aortic wall and there was no bleeding at the sites of penetration of the staples through the aortic wall. In addition, there was no evidence of migration of the attached graft, or signs of thrombus formation or focal haemorrhages within the aortic wall.

The Endogene Pty. Ltd. stapler technique has been successfully used in an animal model with secure graft fixation being easily obtained.

Further research is required before this technology can achieve clinical application. 

 

References 

 

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