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系統識別號 U0026-1408201815470000
論文名稱(中文) 探測胸主動脈血管支架在不同動脈瘤頸形態下的力學表現
論文名稱(英文) Biomechanical study for thoracic stent grafts in different aortic aneurysm neck morphologies
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 106
學期 2
出版年 107
研究生(中文) 江政賢
研究生(英文) Cheng-Hsien Chiang
學號 P88981013
學位類別 博士
語文別 英文
論文頁數 70頁
口試委員 指導教授-葉明龍
共同指導教授-甘宗旦
口試委員-莊漢聲
口試委員-羅偉誠
口試委員-林鼎勝
口試委員-張立東
中文關鍵字 主動脈瘤  主動脈弓  血管內支架  拉拔測試  徑向力  主動脈血管彎曲  主動脈血管擴大 
英文關鍵字 Endovascular aortic repair  Stent graft  Dislodgement force  Pullout test  Radial force  aortic neck angulation  extremely enlarged aortic neck 
學科別分類
中文摘要 主動脈瘤的治療通常為傳統的開胸、開腹進行主動脈人工血管置換手術或是經由導管方式置放主動脈血管內支架(endograft or stent graft)。後者在術後短期的結果上具有良好效益。因為具有潛在發生內滲漏(endo-leak)、血管內支架位移(migration)和體內植入物損壞的風險,置放主動脈血管內支架的病人需要作長期的術後追蹤觀察。
血管內支架的置放需要病人的主動脈瘤上方靠近心臟的近端(proximal site)頸部位置的血管具有合適的形態。近年來由於醫師置放血管內支架的技術提升以及新型式的血管內支架的推陳出新,血管內支架已逐漸開始被置放在動脈瘤頸部位置血管形態上具更短長度、更大徑口以及高度彎曲的病人身上。然而,早期關於血管內支架在動脈血管內固定力大小(fixation)的研究,大部份是在體外實驗使用動物或是人體內一段正常形態的主動脈血管作測試,或是在一個理想形態的腹主動脈瘤的矽膠模型上作測試。在非適當形態血管上的血管內支架的固定力較少有文獻的討論。本論文第一個部份目的在於提供一個體外實驗的研究裝置用來測量和比較不同品牌的胸主動脈血管內支架在不同彎曲程度的血管內,以及在不同支架過度擴張(endograft oversizing)的情形下產生移動所需要的力量大小。第二個部份目的則是探討使用雙腔型血管內支架(Double-Barreled cannon aortic repair)在管徑擴大(enlarged)的主動脈血管的相關固定力分析。雙腔型血管內支架相關固定力的大小將會和正常情形下使用單一血管內支架的固定力大小作比較。
在血管彎曲程度對血管內支架固定力影響的拉拔測試(pullout test)實驗中,三個在台灣常見廠牌的胸主動脈瘤血管內支架:Valiant (管徑:34、36、38、40 mm)、Zenith TX2 (管徑:34、36、38、40 mm)以及TAG(管徑:34、37、40 mm)分別被放置在具有0°、45°、90°、135°彎曲程度的矽膠管內,並在恆溫控制(37℃)的環境下作測試。在擴大型主動脈的血管內支架固定力的研究當中,管徑大小34-42 mm 的Zenith TX2 被使用來探討單一血管內支架的固定力以及雙腔型血管內支架的固定力大小和比較。
在血管彎曲程度對血管內支架的固定力影響的實驗結果顯示,當血管彎曲程度從0度提升到135度時,使Valiant、Zenith TX2、TAG三個廠牌的血管內支架產生位移的力量分別降低了46%、38%、50%。線性迴歸分析顯示血管彎曲對於Valiant和Zenith TX2兩個廠牌的血管內支架的固定力具有顯著的影響。此外,三種廠牌的血管內支架所產生不同的力學結果,以及在不同血管彎曲情形下展現相異的力學反應,顯示出不同廠牌血管內支架設計的差異和區別。
在擴大型主動脈的血管內支架固定力的實驗結果顯示,雙腔型血管內支架可以產生較高的徑向應力以及剪應力而有較好的固定效益。雙腔型血管內支架所產生的徑向應力比單血管支架在正常的受力情況下(支架過度擴張:10-20%)高出15-25%;其所產生的剪應力相當於單血管支架在較高的受力情況下(支架過度擴張:25-35%)的大小。此外,實驗結果顯示Zenith TX2 單血管內支架在相同的受力條件下(支架過度擴張皆在10-20%的範圍),其徑向力以及使其產生位移所需要的力量皆會隨著本身管徑的增加而減少。這樣的力學特性將使得單一血管內支架較不適用於具有擴大型主動脈血管的病患身上。
綜合而論,血管的彎曲的確會對血管內支架的固定造成不良的影響。因此,對於具有彎曲動脈血管的病患,使用比廠商建議還要長的長度來作固定能有較好的結果。使用雙腔型血管內支架可以對血管提供較高的固定效益,然而接受此治療的病患需要持續的追蹤和觀察相關的病情發展。
英文摘要 Serious descending aortic aneurysm is often treated by open surgery or endovascular aortic repair (EVAR). The latter results in effective short-term outcomes. Patients receiving EVAR require lifelong monitoring due to potential risk of endo-leak, stent graft migration or the implant failure.
Patients are eligible for EVAR only when they have favorable morphologies of aortic neck which is in the proximal site of an aneurysm. As physicians are becoming more skillful in endograft techniques and advancing stent graft designs, standard stent grafts have been implanted for shorter, wider or highly angulated aortic necks. However, initial pullout tests of stent grafts were mostly performed in a straight section of animal or cadaveric aortas or in an idealized aortic neck of a silicone abdominal aortic aneurysm model. Stent graft fixation in unfavorable aortic necks was seldom investigated. The purpose of the first part of this study is to provide an apparatus for comparison of dislodgement forces for various thoracic stent grafts at varying neck angulations and oversizing conditions. The purpose of the second part is to investigate the radial stress and shear of employing double stent grafts for an extremely enlarged aortic neck in a laboratory setting. The results are compared with fixation characteristics of single stent grafts for clinical reference and application.
Three commercial stent grafts with sizes commonly used in Taiwan (Valiant: 34, 36, 38, and 40 mm; Zenith TX2: 34, 36, 38, and 40 mm; and TAG: 34, 37, and 40 mm) were employed for pullout test in angulated silicone tubes (0°, 45°, 90°, and 135° with a 32-mm inner diameter) in a temperature-controlled chamber (37 ± 2 ℃). Zenith TX2 endografts of sizes 34–42 mm were used for the fixation study of single stent graft and double stent grafts formation in the extremely enlarged aortic necks.
Results of pullout test in the varying neck angulation settings show mean dislodgement force of Valiant, Zenith TX2 and TAG devices repectively decrease by 46 %, 38 % and 50 % as the neck angulation increases from 0° to 135°. Regression analysis shows that neck angulation was a significant factor for both the Valiant and Zenith TX2 devices. Dislodgement force of the 3 different commercial stent grafts were studied and compared. The different performances of the mean dislodgment forces may reflect the different framework designs of the 3 commercial stent grafts. Our findings indicate that aortic neck angulation has a negative correlation with stent graft fixation.
Results of stent graft fixation in extremely enlarged aortic necks show that the double stent graft formation provides higher radial stress and shear to secure fixation for endovascular aortic repair. The radial stress of the double stent graft formation is 15–25% higher than that of a single stent graft under normal 10–20 % oversizing condition. Shear of the double stent grafts formation is comparable to that of a single stent graft with 25–35 % oversizing condition. In addition, results fixation of single stent graft show that radial stress and shear of a single Zenith TX2 stent graft decrease with increasing endograft diameters. This characteristic makes it more difficult to have secure fixation in an enlarged aortic neck.
In conclusion, aortic neck angulation does have negative correlation with stent graft fixation. For patients with angulated aortic morphologies, having longer contact fixation length and cautiously selected higher endograft oversizing is recommended. Double stent graft formation provides higher fixation than a single stent graft in an enlarged aortic lumen. For patients receiving double-barreled cannon aortic repair, continuously follow up and observation of the disease progression is needed.
論文目次 中文摘要 I
ABSTRACT III
致 謝 V
TABLE OF CONTENTS VI
LIST OF TABLES VIII
LIST OF FIGURES IX
Chapter 1 Introduction 1
1.1. Basics of Human Aorta 1
1.1.1. Anatomy and Physiology of Human Aorta 1
1.1.2. Aortic Aneurysm 2
1.1.3. Other Aortic Diseases 3
1.2. Treatments of Aortic Aneurysms 5
1.2.1. Surgical Aortic Repair 5
1.2.2. Endovascular Aortic Repair 5
1.3. Endovascular Aortic Repair associated Complications 9
1.3.1. Migration of Stent Graft 9
1.3.2. Fracture of Stent Graft 9
1.3.3. Endo-leaks 10
1.4. Fixation Study of Stent Graft in the Literature 13
1.4.1. Radial Force and Radial Stress of Stent Grafts 13
1.4.2. Dislodgement Force or Pullout Force Study 21
1.5. Motivation 36
1.6. Purpose of this study 37
Chapter 2 Materials and Methods 38
2.1. Experimental Set-up for Measuring Dislodgement Force at Varying Aortic Neck Angulations and Oversizing Conditions 38
2.2. Fixation Study of Single and Double Stent Grafts in Enlarged Aortic Necks 43
2.2.1. Experimental Set-up for Radial Force Measurement 43
2.2.2. Experimental Set-up for Dislodgement Force Measurement 46
Chapter 3 Results and Discussion 48
3.1 Influence of Aortic Neck Angulation on Stent Graft Fixation 48
3.1.1 Dislodgement Force at Varying Aortic Neck Angulations and Oversizing Conditions 48
3.1.2 Linear Regression Analysis 51
3.1.3 Discussion 52
3.1.4 Fixative Characteristics of 3 Commercial Stent Grafts 54
3.1.5 Short Summary 55
3.2 Fixation Study of Single and Double Stent Grafts for Extremely Enlarged Aortic Necks 56
3.2.1 Radial Force and Mean Radial Stress of Single Stent Graft and DoBAR 56
3.2.2 Dislodgement Force and Mean Shear of Single Stent Graft and DoBAR 58
3.2.3 Apparent Friction Coefficient 59
3.2.4 Discussion 62
3.2.5 Short Summary 63
3.3 Study Limitations and Future Work 64
Chapter 4 Conclusions 65
References 66
參考文獻 1. Hoffman M. The aorta (human anatomy). Available from: https://www.webmd.com/heart/picture-of-the-aorta#1.
2. Aortic anatomy. Available from: http://www.aortarepair.com/anatomy.html.
3. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. Circulation. 2010;121(13):1544-79.
4. Dwivedi S. Treatment of abdominal aortic aneurysm. 2017; Available from: https://www.medikoe.com/article/Treatment-of-abdominal-aortic-aneurysm-sweling-of-the-aorta--1734.
5. Volodos NL, Karpovich IP, Shekhanin VE, Troian VI, Iakovenko LF. A case of distant transfemoral endoprosthesis of the thoracic artery using a self-fixing synthetic prosthesis in traumatic aneurysm. Grudn Khir. 1988(6):84-6.
6. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Annals of vascular surgery. 1991;5(6):491-9.
7. Chuter TA, Green RM, Ouriel K, Fiore WM, DeWeese JA. Transfemoral endovascular aortic graft placement. Journal of vascular surgery. 1993;18(2):185-95; discussion 95-7.
8. Greiner A, Grommes J, Jacobs MJ. The place of endovascular treatment in abdominal aortic aneurysm. Deutsches Arzteblatt international. 2013;110(8):119-25.
9. Miller DC. Through the looking glass: the first 20 years of thoracic aortic stent-grafting. The Journal of thoracic and cardiovascular surgery. 2013;145(3 Suppl):S142-8.
10. Chaikof EL, Blankensteijn JD, Harris PL, White GH, Zarins CK, Bernhard VM, et al. Reporting standards for endovascular aortic aneurysm repair. Journal of Vascular Surgery. 2002;35(5):1048-60.
11. Thomas B, Sanchez L. Proximal migration and endoleak: impact of endograft design and deployment techniques. Seminars in vascular surgery. 2009;22(3):201-6.
12. Hughes GC, Daneshmand MA, Balsara KR, Achneck HA, Sileshi B, Lee SM, et al. "Hybrid" repair of aneurysms of the transverse aortic arch: midterm results. The Annals of thoracic surgery. 2009;88(6):1882-7; discussion 7-8.
13. Gottardi R, Funovics M, Eggers N, Hirner A, Dorfmeister M, Holfeld J, et al. Supra-aortic transposition for combined vascular and endovascular repair of aortic arch pathology. The Annals of thoracic surgery. 2008;86(5):1524-9.
14. Melissano G, Civilini E, Bertoglio L, Calliari F, Setacci F, Calori G, et al. Results of endografting of the aortic arch in different landing zones. European journal of vascular and endovascular surgery. 2007;33(5):561-6.
15. Czerny M, Grimm M, Zimpfer D, Rodler S, Gottardi R, Hutschala D, et al. Results after endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta. The Annals of thoracic surgery. 2007;83(2):450-5.
16. Lee CJ, Rodriguez HE, Kibbe MR, Malaisrie SC, Eskandari MK. Secondary interventions after elective thoracic endovascular aortic repair for degenerative aneurysms. Journal of vascular surgery. 2013;57(5):1269-74.
17. Lossef SV, Lutz RJ, Mundorf J, Barth KH. Comparison of Mechanical Deformation Properties of Metallic Stents with Use of Stress-Strain Analysis. Journal of Vascular and Interventional Radiology. 1994;5(2):341-9.
18. Dyet JF, Watts WG, Ettles DF, Nicholson AA. Mechanical properties of metallic stents: how do these properties influence the choice of stent for specific lesions? Cardiovascular and interventional radiology. 2000;23(1):47-54.
19. Berry JL, Newman VS, Ferrario CM, Routh WD, Dean RH. A method to evaluate the elastic behavior of vascular stents. Journal of vascular and interventional radiology : JVIR. 1996;7(3):381-5.
20. Wang R, Ravi-Chandar K. Mechanical response of a metallic aortic stent - Part I: Pressure-diameter relationship. Journal of Applied Mechanics. 2004;71(5):697-705.
21. Fallone BG, Wallace S, Gianturco C. Elastic characteristics of the self-expanding metallic stents. Investigative radiology. 1988;23(5):370-6.
22. Duda SH, Wiskirchen J, Tepe G, Bitzer M, Kaulich TW, Stoeckel D, et al. Physical properties of endovascular stents: an experimental comparison. Journal of vascular and interventional radiology : JVIR. 2000;11(5):645-54.
23. Bashar AH, Kazui T, Washiyama N, Terada H, Yamashita K, Haque ME. Mechanical properties of various z-stent designs: an endovascular stent-grafting perspective. Artificial organs. 2003;27(8):714-21.
24. Johnston CR, Lee K, Flewitt J, Moore R, Dobson GM, Thornton GM. The Mechanical Properties of Endovascular Stents: An In Vitro Assessment. Cardiovascular Engineering. 2010;10(3):128-35.
25. Snowhill PB, Nosher JL, Siegel RL, Silver FH. Characterization of radial forces in Z stents. Investigative radiology. 2001;36(9):521-30.
26. De Bock S, Iannaccone F, De Beule M, Van Loo D, Vermassen F, Verhegghe B, et al. Filling the void: a coalescent numerical and experimental technique to determine aortic stent graft mechanics. Journal of biomechanics. 2013;46(14):2477-82.
27. Andrews SM, Anson AW, Greenhalgh RM, Nott DM. In vitro evaluation of endovascular stents to assess suitability for endovascular graft fixation. European journal of vascular and endovascular surgery. 1995;9(4):403-7.
28. Malina M, Lindblad B, Ivancev K, Lindh M, Malina J, Brunkwall J. Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration? Journal of endovascular surgery. 1998;5(4):310-7.
29. Resch T, Malina M, Lindblad B, Malina J, Brunkwall J, Ivancev K. The impact of stent design on proximal stent-graft fixation in the abdominal aorta: an experimental study. European journal of vascular and endovascular surgery. 2000;20(2):190-5.
30. Veerapen R, Dorandeu A, Serre I, Berthet JP, Marty-Ane CH, Mary H, et al. Improvement in proximal aortic endograft fixation: an experimental study using different stent-grafts in human cadaveric aortas. Journal of endovascular therapy. 2003;10(6):1101-9.
31. Kratzberg JA, Golzarian J, Raghavan ML. Role of graft oversizing in the fixation strength of barbed endovascular grafts. Journal of vascular surgery. 2009;49(6):1543-53.
32. Bosman WM, van der Steenhoven TJ, Suarez DR, Valstar ER, de Vries AC, Brom HL, et al. The effect of injectable biocompatible elastomer (PDMS) on the strength of the proximal fixation of endovascular aneurysm repair grafts: an in vitro study. Journal of vascular surgery. 2010;52(1):152-8.
33. Bosman WM, Steenhoven TJ, Suarez DR, Hinnen JW, Valstar ER, Hamming JF. The proximal fixation strength of modern EVAR grafts in a short aneurysm neck. An in vitro study. European journal of vascular and endovascular surgery. 2010;39(2):187-92.
34. Arko FR, Heikkinen M, Lee ES, Bass A, Alsac JM, Zarins CK. Iliac fixation length and resistance to in-vivo stent-graft displacement. Journal of vascular surgery. 2005;41(4):664-71.
35. Lambert AW, Williams DJ, Budd JS, Horrocks M. Experimental assessment of proximal stent-graft (InterVascular) fixation in human cadaveric infrarenal aortas. European journal of vascular and endovascular surgery. 1999;17(1):60-5.
36. Chong CK, How TV, Black RA, Shortland AP, Harris PL. Development of a simulator for endovascular repair of abdominal aortic aneurysms. Annals of biomedical engineering. 1998;26(5):798-802.
37. Chong CK, How TV, Gilling-Smith GL, Harris PL. Modeling endoleaks and collateral reperfusion following endovascular AAA exclusion. Journal of Endovascular Therapy. 2003;10(3):424-32.
38. Chong CK, How TV. Flow patterns in an endovascular stent-graft for abdominal aortic aneurysm repair. Journal of biomechanics. 2004;37(1):89-97.
39. Doyle BJ, Corbett TJ, Cloonan AJ, O'Donnell MR, Walsh MT, Vorp DA, et al. Experimental modelling of aortic aneurysms: novel applications of silicone rubbers. Medical engineering & physics. 2009;31(8):1002-12.
40. Corbett TJ, Callanan A, O'Donnell MR, McGloughlin TM. An improved methodology for investigating the parameters influencing migration resistance of abdominal aortic stent-grafts. Journal of endovascular therapy. 2010;17(1):95-107.
41. Corbett TJ, Molony DS, Callanan A, McGloughlin TM. The effect of vessel material properties and pulsatile wall motion on the fixation of a proximal stent of an endovascular graft. Medical engineering & physics. 2011;33(1):106-11.
42. Vad S, Eskinazi A, Corbett T, McGloughlin T, Vande Geest JP. Determination of coefficient of friction for self-expanding stent-grafts. Journal of biomechanical engineering. 2010;132(12):121007.
43. Wu W, Qi M, Liu XP, Yang DZ, Wang WQ. Delivery and release of nitinol stent in carotid artery and their interactions: A finite element analysis. Journal of biomechanics. 2007;40(13):3034-40.
44. Stather PW, Wild JB, Sayers RD, Bown MJ, Choke E. Endovascular Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy. Journal of Endovascular Therapy. 2013;20(5):623-37.
45. Wu YH, Tseng CC, Kuo TN, Yang YJ, Kan CD. Double-barreled cannon stent grafts: possible solution for extremely dilated landing zone of aorta. The Annals of thoracic surgery. 2011;91(6):1998-2000.
46. Kan CD. Double-barreled cannon stenting for extremely dilated landing zone in a giant thoracoabdominal aneurysm. Journal of vascular surgery. 2014;59(3):828.
47. Shibata T, Hirai H, Fukui T, Aoyama T, Suehiro S. Assembly and deployment of a branched arch stent graft using the transaortic approach. Annals of Thoracic Surgery. 2005;79(5):1790-2.
48. Robich MP, Hagberg R, Schermerhorn ML, Pomposelli FB, Nilson MC, Gendron ML, et al. Hypothermia severely effects performance of nitinol-based endovascular grafts in vitro. The Annals of thoracic surgery. 2012;93(4):1223-7.
49. van Prehn J, Schlosser FJ, Muhs BE, Verhagen HJ, Moll FL, van Herwaarden JA. Oversizing of aortic stent grafts for abdominal aneurysm repair: a systematic review of the benefits and risks. European journal of vascular and endovascular surgery. 2009;38(1):42-53.
50. Zarins CK, Bloch DA, Crabtree T, Matsumoto AH, White RA, Fogarty TJ. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. Journal of vascular surgery. 2003;38(6):1264-72; discussion 72.
51. Canaud L, Cathala P, Joyeux F, Branchereau P, Marty-Ane C, Alric P. Improvement in conformability of the latest generation of thoracic stent grafts. Journal of vascular surgery. 2013;57(4):1084-9.
52. Canaud L, Alric P, Laurent M, Baum TP, Branchereau P, Marty-Ane CH, et al. Proximal fixation of thoracic stent-grafts as a function of oversizing and increasing aortic arch angulation in human cadaveric aortas. Journal of endovascular therapy. 2008;15(3):326-34.
53. Alsac JM, Khantalin I, Julia P, Achouh P, Farahmand P, Capdevila C, et al. The significance of endoleaks in thoracic endovascular aneurysm repair. Annals of vascular surgery. 2011;25(3):345-51.
54. Arthurs ZM, Lyden SP, Rajani RR, Eagleton MJ, Clair DG. Long-term outcomes of Palmaz stent placement for intraoperative type Ia endoleak during endovascular aneurysm repair. Annals of vascular surgery. 2011;25(1):120-6.
55. Gelpi G, Vanelli P, Mangini A, Danna P, Contino M, Antona C. Hybrid aortic arch repair procedure: reinforcement of the aorta for a safe and durable landing zone. European journal of vascular and endovascular surgery. 2010;40(6):709-14.
56. Antoniou GA, Mireskandari M, Bicknell CD, Cheshire NJ, Gibbs RG, Hamady M, et al. Hybrid repair of the aortic arch in patients with extensive aortic disease. European journal of vascular and endovascular surgery. 2010;40(6):715-21.
57. Ueda T, Fleischmann D, Dake MD, Rubin GD, Sze DY. Incomplete endograft apposition to the aortic arch: bird-beak configuration increases risk of endoleak formation after thoracic endovascular aortic repair. Radiology. 2010;255(2):645-52.
58. Canaud L, Alric P, Desgranges P, Marzelle J, Marty-Ane C, Becquemin JP. Factors favoring stent-graft collapse after thoracic endovascular aortic repair. The Journal of Thoracic and Cardiovascular Surgery. 2010;139(5):1153-7.
59. Sincos IR, Aun R, da Silva ES, Belczak S, de Lourdes Higuchi M, Gornati VC, et al. Impact of stent-graft oversizing on the thoracic aorta: experimental study in a porcine model. Journal of endovascular therapy. 2011;18(4):576-84.
60. Torsello GF, Torsello GB, Austermann M. Zenith TX2LowProfile TAA Endovascular Graft: a next generation thoracic stent-graft. The Journal of cardiovascular surgery. 2012;53(2):153-9.
61. Melissano G, Civilini E, Bertoglio L, Logaldo D, Chiesa R. Initial clinical experience with the modified Zenith "Pro-Form" TX2 thoracic endograft. Journal of endovascular therapy. 2010;17(4):463-70.
62. Dong ZH, Fu WG, Wang YQ, Guo da Q, Xu X, Ji Y, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation. 2009;119(5):735-41.
63. Yokoi Y, Azuma T, Yamazaki K. Advantage of a precurved fenestrated endograft for aortic arch disease: simplified arch aneurysm treatment in Japan 2010 and 2011. The Journal of thoracic and cardiovascular surgery. 2013;145(3 Suppl):S103-9.
64. Georgakarakos E, Trellopoulos G, Kontopodis N, Tsetis D, Ioannou CV. The inflatable-rings fixation mechanism of the Trivascular Ovation Stent Graft System: Every revolution comes at a price! The Journal of cardiovascular surgery. 2016; 57(3):479-81.
65. Roy D, Lerouge S, Inaekyan K, Kauffmann C, Mongrain R, Soulez G. Experimental validation of more realistic computer models for stent-graft repair of abdominal aortic aneurysms, including pre-load assessment. International journal for numerical methods in biomedical engineering. 2016;32(12).
66. Almeida MJ, Yoshida WB, Hafner L, Sequeira J, dos Santos JH, Masseno APB, et al. Biomechanical and histologic analysis in aortic endoprosthesis using fibrin glue. Journal of Vascular Surgery. 2011;53(5):1368-74.


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