Harbor-UCLA Medical Center

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Presentation transcript:

Harbor-UCLA Medical Center Chimney, Fenestrated or Hybrid for Thoracic and Abdominal Aortic Aneurysms Rodney White, MD Harbor-UCLA Medical Center

Rodney A. White , MD Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company Grant/Research Support Consulting Fees/Honoraria Medtronic Endologix WL Gore Volcano Abbott

Juxtarenal Aneurysms 4

Fenestrated Grafts

Branched Stent Graft 6

Fenestrated, Debranching & Chimneys for Aortic Aneurysms Cook fenestrated devices pioneered branching technologies - 4 to 6 wks required to custom make devices - limited availability -recent introduction of single-center IDE to evaluate off-shelf fenestrated device

Fenestrated Stent Graft Designed to Treat Short Necks and Juxta-Renal AAA Fits in Existing Main Body Device Off the Shelf Design Cobalt Chromium ePTFE Covered Balloon Expandable Stents for Renals 8

Delivery System Design Integrated 6.5Fr sheaths Compatible with various guidewires and guides Renal cannulation prior to device deployment

Debranching

Criado FJ, et al. Technical Solutions fro Common Problems in TEVAR: Managing Access and Aortic Branches. J Endovasc Ther 2009;16(Suppl 1) 163-179.

Pre-procedure 4 days post-deployment

Chimney Grafts

Danos,et al, Use of Abdominal Chimney Grafts Is Feasible and Safe: Short-term Results. J Endovasc Ther 2010;17:589-593

Loboto, Sandwich Technique for Aortoiliac Aneurysms Extending to the Internal Iliac Artery or Isolated Common/Internal Iliac Artery Aneurysms: A New Endovascular Approach to Preserve Pelvic Circualtion 2011;18:106-111

8.4 cm R. Common Iliac Aneurysm 6.7 cm L. Common Iliac Aneurysm

18Fr sheath L. Lunderquist wire MB x2 Stiff Glide buddy wire in contralateral Int Iliac Avoid internal stent struts Sizing cath R.

“kissing” balloon dilation

Second 16mm x 55mm limb extension Contralateral sheath injection

Completion angiogram

Criado, Chimney Grafts and bare stents: Aortic Branch preservation Revisited. J endovasc Ther 2007;14:823-24

Fenestrated, Debranching & Chimneys for Thoracoabdominal Aneurysms Evolving technology – no approved devices Long-term durability has not been demonstrated