{"id":107931,"date":"2011-11-04T00:00:00","date_gmt":"2011-11-04T00:00:00","guid":{"rendered":""},"modified":"2011-11-04T00:00:00","modified_gmt":"2011-11-04T00:00:00","slug":"desarrollo-de-un-equipo-transportador-de-protesis-bifurcada-monopieza-autoexpandible-para-su-introduccion-fundamentalmente-en-el-sistema-vascular-sistema-traqueobronquial-y-en-la-va%c2%ada-biliar-p","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cirugia-experimental\/desarrollo-de-un-equipo-transportador-de-protesis-bifurcada-monopieza-autoexpandible-para-su-introduccion-fundamentalmente-en-el-sistema-vascular-sistema-traqueobronquial-y-en-la-va%c2%ada-biliar-p\/","title":{"rendered":"Desarrollo de un equipo transportador de pr\u00f3tesis bifurcada monopieza autoexpandible para su introducci\u00f3n, fundamentalmente en el sistema vascular, sistema traqueobronquial y en la v\u00edabiliar, por t\u00e9cnicas percut\u00e1neas propias de la radiolog\u00eda intervencionista"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Miguel Oscar Balboa Arregui <\/strong><\/h2>\n<p>En el contexto de la ateroesclerosis, como enfermedad generalizada, se observa con mucha frecuencia el establecimiento de las lesiones esten\u00f3ticas en importantes bifurcaciones vasculares como la a\u00f3rtica en el s\u00edndrome de leriche, la carot\u00eddea en los ictus o las coronarias en la isquemia mioc\u00e1rdica. El tratamiento endovascular de estas lesiones requiere complicadas maniobras de angioplastia o colocaci\u00f3n de varios stents, generalmente con solapamientos intravasculares, para cubrir adecuadamente las bifurcaciones. El aneurisma de aorta abdominal, tambi\u00e9n relacionado con la degeneraci\u00f3n de la pared arterial, suele afectar a su bifurcaci\u00f3n. El abordaje endovascular de esta patolog\u00eda ha de realizarse con acceso por ambas arterias femorales y con solapamiento endovascular de varias endopr\u00f3tesis. Por otro lado, tanto el desarrollo del carcinoma biliar como el bronquial suele extenderse a las bifurcaciones anat\u00f3micas biliar y traqueobronquial, y con ello dificulta de modo significativo su posible tratamiento paliativo mediante la colocaci\u00f3n de stent para evitar o disminuir su estenosis u obstrucci\u00f3n.  hip\u00f3tesis: la hip\u00f3tesis de esta tesis, y el objetivo principal propuesto en esta investigaci\u00f3n biom\u00e9dica tecnol\u00f3gica, es comprobar la posibilidad de construir un prototipo de stent autoexpandible verdaderamente bifurcado, en una sola pieza, con forma de y, y de su correspondiente dispositivo transportador-liberador para poder desplegarlo en diferentes bifurcaciones anat\u00f3micas animales mediante un \u00fanico acceso percut\u00e1neo. Para ello se han valorado, durante el proceso de colocaci\u00f3n de la pr\u00f3tesis, los distintos grados de dificultad experimentados para el acceso y liberaci\u00f3n de los diferentes prototipos, en funci\u00f3n de las caracter\u00edsticas del dispositivo construido.  materiales y m\u00e9todos: se han construido varios modelos de stents mediante la uni\u00f3n manual (sutura) de stents autoexpandibles monotubulares para formar una estructura en y, con un cuerpo principal y dos ramas distales. Se utilizaron modelos de diferentes caracter\u00edsticas y composiciones: gianturco-roch, smart, symphony, zilver, za y sprinter. A partir de cat\u00e9teres e introductores convencionales se construy\u00f3 un dispositivo transportador-liberador que permite la liberaci\u00f3n independiente de cada rama distal del stent (mediante empuje distal) y del cuerpo principal del stent (mediante retirada) en la bifurcaci\u00f3n elegida. Se experiment\u00f3 la liberaci\u00f3n in vitro y el implante de dichos stents en bifurcaciones anat\u00f3micas del cerdo: vena cava inferior, a\u00f3rtica, tronco bicarot\u00eddeo y \u00e1rbol traqueobronquial, con siete modelos de cada uno de los seis tipos de stents bifurcados construidos.  resultados: ha sido t\u00e9cnicamente posible construir stents verdaderamente bifurcados y un nuevo dispositivo transportador-liberador. La construcci\u00f3n manual de ambos genera un conjunto con algunas zonas de mayor rozamiento y rigidez (suturas, uniones con adhesivo l\u00edquido, etc.). Ha sido t\u00e9cnicamente posible su liberaci\u00f3n e implante en diversas bifurcaciones. Aunque estad\u00edsticamente no se pueden establecer diferencias significativas con respecto a los diferentes grupos de stent, tanto en la facilidad de acceso a la bifurcaci\u00f3n como en la liberaci\u00f3n de los stents el procedimiento ha resultado mejor con el modelo de stent sprinter.  conclusiones: se puede componer un stent propiamente bifurcado y un sistema transportador-liberador apropiado que permite acceder, con una sola punci\u00f3n percut\u00e1nea, a diferentes bifurcaciones anat\u00f3micas. En nuestra investigaci\u00f3n el acceso a la bifurcaci\u00f3n y la liberaci\u00f3n del stent son independientes de los materiales utilizados. El stent de nitinol trenzado, de celda cerrada, con extremos unidos y atraum\u00e1ticos ha permitido un procedimiento m\u00e1s f\u00e1cil.  summary  in the context of atherosclerosis, such as widespread disease, it is very often the development of stenotic lesions in main vascular bifurcations as for example the aortic bifurcation in the leriche syndrome, the carotid artery in stroke or coronary artery in myocardial ischemia. Endovascular treatment of these injuries requires complicated angioplasty maneuvers or multiple stent placements (frequently with intravascular overlapping) to adequately cover the branches. Abdominal aortic aneurysm, also related to the arterial wall degeneration, usually involves the bifurcation. The endovascular approach to these lesions requires access by both femoral arteries and several endovascular stent overlap. On the other hand, the development of biliary and bronchial carcinomas frequently spreads to the tracheobronchial and biliary bifurcations, and thereby, significantly impedes possible palliative treatment by stenting, which would avoid or reduce stenosis and obstruction.  hypothesis: the hypothesis of this thesis and principal objective proposed in this technological biomedical research is to demonstrate the possibility of building a truly self-expanding bifurcated stent prototype, in one piece, y-shaped, and their respective carrier-releasing device to deliver it in different animal anatomical bifurcations by a single percutaneous access. This has been rated during the implant placement, experimenting different difficulty degrees in the access and release of the different prototypes, depending on the device characteristics.  materials and methods: several models of stents have been built by manual suture binding of self-expanding and monotubular stents to form a single y-structure, with a main body and two distal branches. Models with different characteristics and compositions were used: gianturco-roch, smart, symphony, zilver, za and sprinter. From conventional catheters and introducers a carrier-releasing device was built, which allows the independent release of each distal branch (by distal pushing) and the main body of the stent (by pulling back) in the chosen anatomical bifurcation. These stents were tested for in vitro release and placement in swine anatomical bifurcations: inferior vena cava, aorta, carotid trunk and tracheobronchial tree, with seven models per each of the six prototypes of bifurcated stents built.  results: it has been technically possible to build truly bifurcated stents and a new carrier-releasing device. The manual construction of both generates structures with some areas of increased friction and stiffness (sutures, liquid adhesive joints, etc). It has been technically possible to release and expand them in different bifurcations. Although no statistically significant differences were shown between the different stent groups, neither in the access simplicity to the bifurcation nor in the release of the stent, the procedure was better with sprinter stent model.  conclusions: we can compose a truly bifurcated stent and a carrier-release system which allows access, with a single percutaneous puncture, to different anatomical bifurcations. The bifurcation access and stent release is independent of materials used in our investigation. The braided nitinol stent, closed cell with attached and atraumatic ends has allowed an easier procedure.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Desarrollo de un equipo transportador de pr\u00f3tesis bifurcada monopieza autoexpandible para su introducci\u00f3n, fundamentalmente en el sistema vascular, sistema traqueobronquial y en la v\u00edabiliar, por t\u00e9cnicas percut\u00e1neas propias de la radiolog\u00eda intervencionista<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Desarrollo de un equipo transportador de pr\u00f3tesis bifurcada monopieza autoexpandible para su introducci\u00f3n, fundamentalmente en el sistema vascular, sistema traqueobronquial y en la v\u00edabiliar, por t\u00e9cnicas percut\u00e1neas propias de la radiolog\u00eda intervencionista <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Miguel Oscar Balboa Arregui <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Le\u00f3n<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 11\/04\/2011<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Jos\u00e9 Manuel Gonzalo Orden<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Jos\u00e9 manuel Gonzalo cordero <\/li>\n<li>mario Manuel Dinis ginja (vocal)<\/li>\n<li>Jos\u00e9 Manuel Pumar cebreiro (vocal)<\/li>\n<li>Jos\u00e9 mart\u00edn Carreira villamor (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Miguel Oscar Balboa Arregui En el contexto de la ateroesclerosis, como enfermedad generalizada, se observa con mucha 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