Biomedical Engineering Reference
In-Depth Information
et al., 1983), and employing a compliant and biodegradable graft that will promote regeneration of arte-
rial wall in small caliber vessels (Van der Lei et al., 1985, 1986) are a few examples of such improvements.
9.1.4.3 Transluminally Placed Endovascular Prostheses (Stent-Grafts)
Endoluminal approaches to treating vascular disease involve the insertion of a prosthetic device into the
vasculature through a small, often percutaneous, access site created in a remote vessel, followed by the intra-
luminal delivery and deployment of a prosthesis via transcatheter techniques (Veith et al., 1995). In con-
trast to conventional surgical therapies for vascular disease, the use of transluminally placed endovascular
prostheses are distinguished by their “minimally invasive” nature. Because these techniques do not require
extensive surgical intervention, they have the potential to simplify the delivery of vascular therapy, improve
procedural outcomes, decrease procedural costs, reduce morbidity, and broaden the patient population that
may benefit from treatment. Not surprisingly, endoluminal therapies have generated intense interest within
the vascular surgery, interventional radiology, and cardiology communities over recent years.
The feasibility of using transluminally placed endovascular prostheses, or stent-grafts, for the treat-
ment of traumatic vascular injury (Marin et al., 1994), atherosclerotic obstructions (Cragg and Dake,
1993), and aneurysmal vascular disease (Parodi et al., 1991; Dake et al., 1994; Yusuf et al., 1994) has been
demonstrated in human beings. Endoluminal stent-grafts continue to evolve to address a number of
cardiovascular pathologies at all levels of the arterial tree. Figure 9.10a depicts endoluminal stent-grafts
FIGURE 9.10
(a) Endoluminal stent-grafts of straight and bifurcated configurations and sizes currently under
clinical investigation. (b) A stent-graft implant consisting of an ePTFE graft that is externally supported by a self-
expanding nitinol stent. (Courtesy of W.L. Gore and Associates, Inc., Flagstaff, AZ.)
