Directional tip control technique for optimal stent graft alignment in angulated proximal aortic landing zones Toshio Takayama, MD, PhD, Patrick J. Phelan,

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Presentation transcript:

Directional tip control technique for optimal stent graft alignment in angulated proximal aortic landing zones Toshio Takayama, MD, PhD, Patrick J. Phelan, MD, Jon S. Matsumura, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 3, Issue 2, Pages 51-56 (June 2017) DOI: 10.1016/j.jvscit.2017.02.010 Copyright © 2017 The Authors Terms and Conditions

Fig 1 Overview of the directional tip control technique. A, Infrarenal abdominal aortic aneurysm with angulated neck. B, Stent graft device does not fit the angulation by standard approach. C, Exchange the stiff wire to a floppy wire and snare it to create a through-and-through wire between bilateral groin access sites. D, Insert a steerable guiding sheath or angulated guiding catheter over the through-and-through wire from contralateral access site. Engage the tip of the guiding sheath or catheter to the device tip. E, Adjust the position of the device by manipulating the engaged guiding sheath or catheter so that the device fits the angulation of the aorta. F, Precisely deployed stent graft. Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 51-56DOI: (10.1016/j.jvscit.2017.02.010) Copyright © 2017 The Authors Terms and Conditions

Fig 2 An endovascular aneurysm repair (EVAR) case with the directional tip control technique. A, Preoperative computed tomography (CT) angiogram demonstrates infrarenal neck angle of 35 degrees. B, There was mural thrombus in the aneurysm neck (arrow). C, A 6.5F steerable guiding sheath engages to the stent graft device tip over the through-and-through wire (arrow). D, Deflected stent graft device position by manipulating the engaged steerable guiding sheath (arrowhead). E, Postoperative CT angiogram demonstrates an EVAR stent graft deployed orthogonal to the aortic centerline, just below the left renal artery. Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 51-56DOI: (10.1016/j.jvscit.2017.02.010) Copyright © 2017 The Authors Terms and Conditions

Fig 3 A thoracic endovascular aortic repair (TEVAR) case with the directional tip control technique. A, Preoperative computed tomography (CT) angiogram demonstrates that the angle between the centerlines of aortic arch zone 2 and proximal descending aorta was 70 degrees. B, A 5F angled catheter engages to the stent graft device tip over the through-and-through wire (arrow). Note that the through-and-through wire was between groin access and left brachial artery access. C, Deflected stent graft device position by manipulating the engaged catheter (arrowhead). D, Stent graft deployed parallel to the aortic arch without bird-beak configuration. E, Postoperative CT angiogram demonstrates well-aligned stent grafts and patent left subclavian artery snorkel stent. Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 51-56DOI: (10.1016/j.jvscit.2017.02.010) Copyright © 2017 The Authors Terms and Conditions