Elsa Madeleine Faure1, Ludovic Canaud2, Philippe Cathala3, Isabelle Serres4, Charles Marty-Ané5, Pierre Alric6. 1. Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Laboratory of Experimental Surgery, Lapeyronie Hospital, Montpellier, France; Legal Department, Lapeyronie Hospital, Montpellier, France. Electronic address: elsafaure@hotmail.com. 2. Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Laboratory of Experimental Surgery, Lapeyronie Hospital, Montpellier, France; Legal Department, Lapeyronie Hospital, Montpellier, France. 3. Legal Department, Lapeyronie Hospital, Montpellier, France. 4. Department of Anatomopathology, Lapeyronie Hospital, Montpellier, France. 5. Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. 6. Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Laboratory of Experimental Surgery, Lapeyronie Hospital, Montpellier, France; National institute of health and medical research (INSERM) U1046, University of Montpellier 1, University Hospital of Montpellier, Montpellier, France.
Abstract
OBJECTIVE: To report a new human ex vivo model of type B aortic dissection (TBAD) and to assess if the locations of the primary entry tear determine the patterns of dissection propagation. METHODS: Twenty fresh human aortas were harvested. TBADs were surgically initiated 2 cm below the left subclavian artery at four different locations (lateral, n = 5; medial, n = 5; anterior, n = 5; posterior, n = 5). Aortas were thereafter connected to a bench-top pulsatile flow model to induce antegrade propagation of the dissection. RESULTS: Antegrade propagation of the dissection was achieved and reached at least the celiac trunk (CT) in all the cases. Dissection was propagated to the renal aorta in 16 (80%) and infrarenal aorta in seven cases (35%). Left renal artery with or without the CT originated more often from the false channel when primary entry tear was lateral. Right renal artery and the CT most often originated from the false channel when primary entry tear was medial. When the CT was the only one originating from the false channel, primary entry tear was more often anterior, whereas when it originated from the true channel, it was more often posterior. CONCLUSIONS: This human ex vivo model of TBAD is reproducible, since, in all the aortas, extended dissection was achieved and provides the first model of human aortic dissection with infrarenal aorta extension allowing future assessment of endovascular devices developed for human use. Furthermore, it allows clarification of the patterns of aortic dissection propagation and visceral and renal artery involvement according to the site of the primary entry tear.
OBJECTIVE: To report a new human ex vivo model of type B aortic dissection (TBAD) and to assess if the locations of the primary entry tear determine the patterns of dissection propagation. METHODS: Twenty fresh human aortas were harvested. TBADs were surgically initiated 2 cm below the left subclavian artery at four different locations (lateral, n = 5; medial, n = 5; anterior, n = 5; posterior, n = 5). Aortas were thereafter connected to a bench-top pulsatile flow model to induce antegrade propagation of the dissection. RESULTS: Antegrade propagation of the dissection was achieved and reached at least the celiac trunk (CT) in all the cases. Dissection was propagated to the renal aorta in 16 (80%) and infrarenal aorta in seven cases (35%). Left renal artery with or without the CT originated more often from the false channel when primary entry tear was lateral. Right renal artery and the CT most often originated from the false channel when primary entry tear was medial. When the CT was the only one originating from the false channel, primary entry tear was more often anterior, whereas when it originated from the true channel, it was more often posterior. CONCLUSIONS: This human ex vivo model of TBAD is reproducible, since, in all the aortas, extended dissection was achieved and provides the first model of human aortic dissection with infrarenal aorta extension allowing future assessment of endovascular devices developed for human use. Furthermore, it allows clarification of the patterns of aortic dissection propagation and visceral and renal artery involvement according to the site of the primary entry tear.