Hybrid Laparoscopic Circular Stapling For Aneurysm Repair

Main Category: Vascular
Also Included In: Medical Devices / Diagnostics;  Genetics
Article Date: 30 Jun 2007 - 1:00 PDT

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Will mechanical stapling devices ever provide a fixation equal to or better than sutures? Will a stapler provide a completed laparoscopic anastomosis that is smooth and provides proximal fixation strength and sealing characteristics? Are the graft integrity, graft patency, and attachment seal compromised by calcified deposit in the artery wall?

Stent-graft fixation for the repair of abdominal aortic aneurysm (AAA) relies on the radial overextension of the stent scaffold at the inner walls of the aorta and iliac arteries. Oversizing can result in metal fatigue, as well as proximal stent-graft migration and endoleaks due to the pressures within the aorta that can range from 120 mm Hg pressure up to 200 mm Hg pressure. Without adequate attachment, a stent-graft leaks around the edges. The constant blood flow and regular peristaltic oscillations of the abdominal aorta, causes the stent-graft to migrate from its original position, which could result in the death of the patient because of the subsequent rupture of the aneurysm sack.

At least five device companies are currently in a design and test phase to provide secure fixation of the proximal edge of a stent-graft to the infrarenal aorta. In the past, several attempts have been undertaken for designing an endoluminal stapler device that is suitable for the task. If the walls of the aortic neck of an aneurysm are calcified and covered by calcium plaques, substantial forces are required for drilling staple holes through the walls of the stent-graft and the aortic wall. Therefore the progress in developing a reliable stapling device has been quite slow in view of the many difficulties in applying mechanical anastomosis techniques.

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