Air bubbles are released by thoracic endograft deployment: An in vitro experimental study

Kamuran Inci, Giasemi Koutouzi, Valery Chernoray, Anders Jeppsson, Håkan Nilsson, Mårten Falkenberg, Kamuran Inci, Giasemi Koutouzi, Valery Chernoray, Anders Jeppsson, Håkan Nilsson, Mårten Falkenberg

Abstract

Purpose: Embolic stroke is a dreaded complication of thoracic endovascular aortic repair. The prevailing theory about its cause is that particulate debris from atherosclerotic lesions in the aortic wall are dislodged by endovascular instruments and embolize to the brain. An alternative source of embolism might be air trapped in the endograft delivery system. The aim of this experimental study was to determine whether air is released during deployment of a thoracic endograft.

Methods: In an experimental benchtop study, eight thoracic endografts (five Medtronic Valiant Thoracic and three Gore TAG) were deployed in a water-filled transparent container drained from air. Endografts were prepared and deployed according to their instructions for use. Deployment was filmed and the volume of air released was collected and measured in a calibrated syringe.

Results: Air was released from all the endografts examined. Air volumes ranged from 0.1 to 0.3 mL for Medtronic Valiant Thoracic and from <0.025 to 0.04 mL for Gore TAG. The largest bubbles had a diameter of approximately 3 mm and came from the proximal end of the Medtronic Valiant device.

Conclusion: Air bubbles are released from thoracic endografts during deployment. Air embolism may be an alternative cause of stroke during thoracic endovascular aortic repair.

Keywords: Air; embolism; experimental; stroke; thoracic endovascular aortic repair.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Experimental setup. The container (1) was mounted at an angle of 40°. The container and the access tubing (2) were filled with room-tempered water, free from air. The endografts were inserted through the access tubing over a 0.035-inch guide wire (3). Deployment was recorded with a high-speed camera (4) and the total volume of bubbles collected was measured using a Luer-lock syringe barrel mounted on the top of the container (5). A white shield (6) was used as background to improve the image quality.
Figure 2.
Figure 2.
(a) Photograph of a Valiant Thoracic endograft deployment in the water-filled container, (b) magnification of (a) showing an air bubble released from inside the endograft during sheath retraction, (c) video of (b), (d) air bubbles released from distal end of Valiant Thoracic endograft, (e) video of (d), (f) air bubbles from proximal end of a Valiant Thoracic when the top stent is released, (g) video of (f), (h) large bubble released from proximal end of Valiant Thoracic endograft, and (i) video of (h).

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