A Study of Pullout Forces of the Components of Modular Multi-manufacturer Hybrid Endografts Used for Aortic Aneurysm Repair

Objectives: Aorto-iliac angulations may be challenging for modular stent-graft systems (SGSs) from a single manufacturer. This study aims to define the pullout forces (POFs) of SGSs derived from the same (non-hybrid) or different manufacturers (hybrid). Methods: The POFs were tested in a vertical position in air and 5% albumin. We studied the POFs between legs from Anaconda (Vascutek (R)), Excluder (Gore (R)), Talent (Medtronic (R)) and Zenith (Cook) with the contralateral limb of bifurcated aortic bodies from Zenith (12 mm), Anaconda and Excluder. Results: For non-hybrid SGSs, the POFs decreased in the following order: Anaconda (11.2 +/- 0.6 N), Talent (6.25 +/- 0.6 N), Zenith (3.5 +/- 0.01 N) and Excluder (2.5 +/- 0.5 N). The Zenith body with the Anaconda limb (15 mm) registered the greatest POF (13.083 +/- 0.821 N); the Zenith and Excluder bodies combined with the Excluder limb (16 mm) registered the weakest POFs (2.397 +/- 0.22 N and 2.500 +/- 0.479 N, respectively). The Zenith body combined with the Excluder limb (16 mm) had a POF similar to the Zenith non-hybrid; combined with Talent 14 mm and Anaconda limb exhibited POFs greater than the Zenith non-hybrid system. For the Limb-to-limb POFs, the greatest was registered for the Anaconda limb, 13 mm within a 12-mm extension for 40-mm overlaps (23.06 +/- 0.480 N); the weakest POFs were recorded for the Excluder limbs at 30-mm overlaps (1.09 +/- 0.167 N and 1.11 +/- 0.250 N). Conclusions: The hybrid SGSs performed as well as or better than the non-hybrid systems, and should be considered for clinical testing in patients whose unique anatomy warrants the flexibility that the use of hybrids provides. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.