Abdominal Aortic Endograft Implantation Immediately Induces Vascular Stiffness Gradients That May Promote Adverse Aortic Neck Dilatation: Results of A Porcine Ex Vivo Study.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2025-02-01 Epub Date: 2023-05-08 DOI:10.1177/15266028231169178
Isabel N Schellinger, Jörg Naumann, Annett Hoffmann, Sarah-Jane Barnard, Sandra Düsing, Markus U Wagenhäuser, Josephina Haunschild, Dierk Scheinert, Gerd Hasenfuß, Christian D Etz, Uwe Raaz
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Abstract

Purpose: Endovascular aortic repair (EVAR) is the method of choice for most abdominal aortic aneurysm (AAA) patients requiring intervention. However, chronic aortic neck dilatation (AND) following EVAR progressively weakens the structural seal between vessel and endograft and compromises long-term results of the therapy. This experimental ex vivo study seeks to investigate mechanisms of AND.

Materials and methods: Porcine abdominal aortas (n=20) were harvested from slaughterhouse pigs and connected to a mock circulation. A commercially available endograft was implanted (n=10) or aortas were left untreated as controls (n=10). Vascular circumferential strain was assessed via ultrasound in defined aortic segments as a parameter of aortic stiffness. Histology and aortic gene expression analysis were performed to investigate potential changes of aortic wall structure and molecular differences due to endograft implantation.

Results: We found that endograft implantation acutely induces a significant stiffness gradient directly at the interface between stented and unstented aortic segments under pulsatile pressure. Comparing stented aortas with unstented controls, we detected increased aortic expression levels of inflammatory cytokines (Il6 and Ccl2) and matrix metalloproteinases (Mmp2 and Mmp9) after 6 hours of pulsatile pressurization. This effect, however, was abolished when repeating the same experiment under 6 hours of static pressure.

Conclusions: We identified endograft-induced aortic stiffness gradients as an early trigger of inflammatory aortic remodeling processes that might promote AND. These results highlight the importance of adequate endograft designs to minimize vascular stiffness gradients and forestall late complications, such as AND.

Clinical impact: AND may compromise the long-term results following endovascular aortic repair. However, the mechanisms behind the underlying detrimental aortic remodeling are still unclear. In this study we find that endograft-induced aortic stiffness gradients induce an inflammatory aortic remodeling response consistent with AND. This novel pathomechanistic insight may guide the design of new aortic endografts that minimize vascular stiffness gradients and forestall late complications such as AND.

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一项猪离体研究的结果表明,腹主动脉内移植物植入会立即诱导血管僵硬梯度,从而可能促进不利的主动脉颈扩张。
目的:血管内主动脉修复(EVAR)是大多数需要介入治疗的腹主动脉瘤(AAA)患者的首选方法。然而,EVAR后的慢性主动脉颈扩张(AND)会逐渐削弱血管和内移植物之间的结构密封,影响治疗的长期效果。本实验旨在探讨AND的机制。材料和方法:猪腹主动脉(n=20)取材于屠宰场的猪,并连接到模拟循环系统。植入市售的内移植物(n=10)或不治疗主动脉作为对照(n=10)。通过超声在确定的主动脉段中评估血管周向应变,作为主动脉硬度的参数。通过组织病理学和主动脉基因表达分析,探讨主动脉壁结构的潜在变化和分子差异。结果:我们发现在脉动压力下,血管内植入术直接在支架和未支架主动脉段之间的界面处引起明显的刚度梯度。将支架置入的主动脉与未支架置入的对照组进行比较,我们检测到在脉动加压6小时后,主动脉炎症细胞因子(Il6和Ccl2)和基质金属蛋白酶(Mmp2和Mmp9)的表达水平升高。然而,当在6小时的静压下重复同样的实验时,这种影响就消失了。结论:我们确定了内移植物诱导的主动脉僵硬梯度是炎症性主动脉重塑过程的早期触发因素,可能会促进AND。这些结果强调了适当的内移植物设计的重要性,以尽量减少血管僵硬梯度和预防晚期并发症,如and。临床影响:AND可能影响血管内主动脉修复后的长期结果。然而,潜在的有害主动脉重构背后的机制仍不清楚。在这项研究中,我们发现内移植诱导的主动脉僵硬梯度诱导了与AND一致的炎症性主动脉重塑反应。这一新颖的病理力学见解可以指导新的主动脉内移植物的设计,从而最大限度地减少血管僵硬梯度并预防晚期并发症,如and。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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