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. 2024 Apr 25;11(5):134.
doi: 10.3390/jcdd11050134.

Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations-An In Vitro Study

Artúr Hüttl  1 , Tin Dat Nguyen  1 , Sarolta Borzsák  1   2 , András Süvegh  1 , András Szentiványi  1 , István Szilvácsku  3 , Dóra Kovács  3 , János Dobránszky  4 , Péter Sótonyi  2   5 , Csaba Csobay-Novák  1   2
Affiliations

Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations-An In Vitro Study

Artúr Hüttl et al. J Cardiovasc Dev Dis. .

Abstract

Background: We conducted an in vitro comparison of the snare loop reinforcement against a closed-loop reinforcement (Hungaroring) for physician-modified endograft (PMEG) fenestrations regarding preparation time and stability during flaring balloon dilatation.

Materials and methods: The time to complete a PMEG fenestration with reinforcement was measured and compared between the Hungaroring and snare loop groups. The number of stitches was counted. Each fenestration was dilated using a 10 mm high-pressure, non-compliant balloon up to 21 atm in pressure, and fluoroscopic images were taken. The presence of indentation on the oversized balloon at the level of the reinforcement was evaluated at each fenestration.

Results: Five fenestrations were created in each group (n = 5) for a total of ten pieces. The completion time in the snare loop group was 1070 s (IQR:1010-1090) compared to 760 s (IQR:685-784) in the Hungaroring group (p = 0.008). Faster completion time was achieved by faster stitching (23.2 s/stitch (IQR 22.8-27.3) for the snare loop group and 17.3 s/stitch (IQR 17.3-20.1) for the Hungaroring group (p = 0.016). None of the fluoroscopic images of the snare loop reinforcement showed an indentation on the balloon during the overexpansion; on the contrary, the Hungaroring showed indentation in every case, even at 21 atm.

Conclusion: Fenestrations reinforced with Hungaroring can be completed significantly faster. Furthermore, the Hungaroring resists over-dilation even at high pressures, while snare loop reinforcements dilate at nominal pressure.

Keywords: endovascular aortic repair; fenestration; physician-modified endograft; reinforcement.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) No indentation even below 8 atm (B) Hungaroring resisted over-expansion even at 21 atm.
Figure 2
Figure 2
Macro images of the fenestration reinforcement both pre- and post-dilation. (A) Snare loop reinforcement pre-dilation; (B) flaring maneuver with no indentation; (C) snare loop reinforcement post-dilation; (D) Hungaroring pre-dilation; (E) flaring maneuver with visible indentation; and (F) post-dilation.
See this image and copyright information in PMC

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