EndoEx: Benchtop and cadaveric evaluation of a novel endograft removal device

Endovascular abdominal aortic aneurysm repair has improved short-term patient outcomes as compared with open techniques. However, endograft complications, particularly infection and endoleaks, may necessitate the removal of the graft and fixation spines. Current explanation techniques are limited, often relying on repurposed tools like modified syringes, which can damage the aortic wall or nearby vessels during removal and lead to serious complications, such as aortic dissection, renal injury, and catastrophic bleeding, with mortality rates of up to 30%. In response, the EndoEx device was developed, designed specifically for safe and controlled graft removal, especially regarding the suprarenal fixation spines. The device uses specific geometry and features designed to limit the mechanical damage associated with vessel trauma and improve ease of use. This study compared EndoEx with the current standard of care, a modified syringe, through benchtop hydrogel testing, ex vivo bovine aorta models, and cadaveric explantation of suprarenal Cook stent grafts. EndoEx showed a smaller damaged surface area in benchtop hydrogel testing as compared with the modified syringe (0 ± 0 cm² vs 3.97 ± 0.2 cm²), elimination of the snow-plowing effect during animal tissue testing, and less gross damage during cadaveric explantation. This study demonstrates that the EndoEx device significantly reduces mechanical damage in experimental, animal tissue, and preliminary human cadaveric models. This reduction in damage may confer a reduction in aortic wall injury during graft explantation, potentially leading to a safer and more effective solution that may substantially decrease morbidity and mortality in complex explant procedures of endovascular abdominal aortic aneurysm repair devices.