In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization Richard.

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Presentation transcript:

In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization Richard E. Redlinger, MD, Sadaf S. Ahanchi, MD, Jean M. Panneton, MD Journal of Vascular Surgery Volume 58, Issue 5, Pages 1171-1177 (November 2013) DOI: 10.1016/j.jvs.2013.04.045 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Left, The laser catheter is placed at the ostium of the left subclavian artery (LSA) perpendicular to the endograft over a 0.018-inch wire. To create a clean, circular fenestration, the laser fiber should ideally be oriented at a 90° angle to the endograft. Right, After laser activation, the laser catheter is advanced through the endograft. Journal of Vascular Surgery 2013 58, 1171-1177DOI: (10.1016/j.jvs.2013.04.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 The laser fiber is gently advanced to make contact with the Dacron endograft, followed by laser energy application for 3 to 5 seconds to create the fenestration. An 0.018-inch wire is advanced through the laser catheter and fenestration into the endograft lumen and exchanged for a stiff 0.035-inch wire. Journal of Vascular Surgery 2013 58, 1171-1177DOI: (10.1016/j.jvs.2013.04.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 The iCAST stent is deployed from the brachial access approximately one-quarter into the endograft lumen and three-quarters into the branch vessel. Journal of Vascular Surgery 2013 58, 1171-1177DOI: (10.1016/j.jvs.2013.04.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 The etiology of presentation of the 22 patients undergoing thoracic endovascular aortic repair (TEVAR) with in situ retrograde laser fenestration. IMH, Intramural hematoma; PAU, penetrating aortic ulcer. Journal of Vascular Surgery 2013 58, 1171-1177DOI: (10.1016/j.jvs.2013.04.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5 Left subclavian artery (LSA) stent patency, without evidence of endoleak and stable aortic size are demonstrated on 39-month follow-up (left) computed tomography angiography and a (right) volume-rendered image. Journal of Vascular Surgery 2013 58, 1171-1177DOI: (10.1016/j.jvs.2013.04.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions